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Ke Q, He J, Cai L, Lei X, Huang X, Li L, Liu J, Guo W. Safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy associated with spontaneous portosystemic shunts. Sci Rep 2024; 14:14848. [PMID: 38937539 PMCID: PMC11211343 DOI: 10.1038/s41598-024-65690-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024] Open
Abstract
This study aimed to assess the safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy (HE) associated with large spontaneous portosystemic shunts (SPSS). Inverse probability of treatment weighting (IPTW) was employed to minimize potential bias. A total of 123 patients were included in this study (34 in the embolization group and 89 in the control group). In the unadjusted cohort, the embolization group demonstrated significantly better liver function, a larger total area of SPSS, and a higher percentage of patients with serum ammonia levels > 60 µmol/L and the presence of hepatocellular carcinoma (HCC) (all P < 0.05). In the IPTW cohort, baseline characteristics were comparable between the two groups (all P > 0.05). Patients in the embolization group exhibited significantly longer HE-free survival compared to the control group in both the unadjusted and IPTW cohorts (both P < 0.05). Subsequent subgroup analyses indicated that patients with serum ammonia level > 60 μmol/L, hepatopetal flow within the portal trunk, the presence of solitary SPSS, a baseline HE grade of II, and the absence of HCC at baseline showed statistically significant benefit from embolization treatment (all P < 0.05). No early procedural complications were observed in the embolization group. The incidence of long-term postoperative complications was comparable to that in the control group (all P > 0.05). Hence, interventional embolization appears to be a safe and effective treatment modality for cirrhotic patients with refractory HE associated with large SPSS. However, the benefits of embolization were discernible only in a specific subset of patients.
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Affiliation(s)
- Qiao Ke
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 66, Jintang Road, Fuzhou, 350025, Fujian, People's Republic of China
- Department of Hepatopancreatobiliary Surgery, Clinical Oncology School of Fujian Medical University, No. 420, Fuma Road, Fuzhou, 350014, Fujian, People's Republic of China
| | - Jian He
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 66, Jintang Road, Fuzhou, 350025, Fujian, People's Republic of China
| | - Linsheng Cai
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 66, Jintang Road, Fuzhou, 350025, Fujian, People's Republic of China
- Department of Hepatopancreatobiliary Surgery, Clinical Oncology School of Fujian Medical University, No. 420, Fuma Road, Fuzhou, 350014, Fujian, People's Republic of China
| | - Xiaojuan Lei
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 66, Jintang Road, Fuzhou, 350025, Fujian, People's Republic of China
| | - Xinhui Huang
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 66, Jintang Road, Fuzhou, 350025, Fujian, People's Republic of China
| | - Ling Li
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 66, Jintang Road, Fuzhou, 350025, Fujian, People's Republic of China
| | - Jingfeng Liu
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 66, Jintang Road, Fuzhou, 350025, Fujian, People's Republic of China.
- Department of Hepatopancreatobiliary Surgery, Clinical Oncology School of Fujian Medical University, No. 420, Fuma Road, Fuzhou, 350014, Fujian, People's Republic of China.
| | - Wuhua Guo
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 66, Jintang Road, Fuzhou, 350025, Fujian, People's Republic of China.
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Ke Q, Yu X, Wang X, Huang J, Lin B, He J, Wang Z, Huang X, Weng X, Jiao Y, Xie Y, Wu W, Qiu L, Li L, Xu Z, Su Z, Zhuge Y, Liu J, Guo W. Prevalence, clinical characteristics, and outcomes of spontaneous portosystemic shunt in patients with hepatitis B-related cirrhosis: A multicenter study from China. Dig Liver Dis 2023; 55:1382-1390. [PMID: 37164894 DOI: 10.1016/j.dld.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND The impact of spontaneous portosystemic shunt (SPSS) on decompensated events and mortality for patients with hepatitis B-related cirrhosis remains poorly investigated. AIMS To evaluate the prevalence, clinical characteristics, and outcomes of SPSS among patients with hepatitis B-related cirrhosis. METHODS Patients who were diagnosed with hepatitis B-related cirrhosis were retrospectively recruited. All eligible patients were classified into SPSS and non-SPSS groups and their clinical characteristics and outcomes were compared and analyzed. RESULTS Of the 1282 patients included in this study, SPSS was identified in 488 patients (38.1%). SPSS group had more severe liver function impairment, higher prevalence and severity of esophageal and gastric varices (EGV), and a higher prevalence of EGV bleeding (EGVB), portal vein thrombosis (PVT), hepatic encephalopathy (HE), ascites, and hepatocellular carcinoma (HCC, all P<0.05). During the follow-up period, SPSS group experienced a significantly higher incidence of EGVB, PVT, and HE (all P<0.05); however, there was no significant difference in the incidence of ascites, HCC, and mortality between the two groups (all P>0.05). CONCLUSION With hepatitis B-related cirrhosis, SPSS was common and characterized by severe liver damage and a high prevalence of decompensated events. Moreover, patients with SPSS had higher risks of EGVB, PVT, and HE.
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Affiliation(s)
- Qiao Ke
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China; Department of Hepatopancreatobiliary Surgery, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China
| | - Xueping Yu
- Department of Infectious Disease, The First Hospital of Quanzhou, affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Xuan Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jinfa Huang
- The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, Quanzhou, Fujian, China
| | - Biding Lin
- Department of Infectious Disease, Fuding Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuding, Fujian, China
| | - Jian He
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Zhiyong Wang
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xinhui Huang
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiadi Weng
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yubin Jiao
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yixing Xie
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Weimin Wu
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Linbin Qiu
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Ling Li
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Zhengju Xu
- The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, Quanzhou, Fujian, China
| | - Zhijun Su
- Department of Infectious Disease, The First Hospital of Quanzhou, affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Yuzhen Zhuge
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Jingfeng Liu
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China; Department of Hepatopancreatobiliary Surgery, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China.
| | - Wuhua Guo
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China.
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Ke Q, He J, Huang X, Li L, Liu J, Guo W. Spontaneous portosystemic shunts outside the esophago-gastric region: Prevalence, clinical characteristics, and impact on mortality in cirrhotic patients: A systematic review and meta-analysis. Eur J Intern Med 2023; 112:77-85. [PMID: 36990875 DOI: 10.1016/j.ejim.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Spontaneous portosystemic shunt (SPSS) other than esophago-gastric varices is one of the consequences of cirrhosis-induced portal hypertension (PHT), but its role is not fully understood. Therefore, we conducted a systematic review and meta-analysis to determine the prevalence and clinical characteristics of SPSS (excluding esophago-gastric varices) and its impact on mortality in patients with cirrhosis. METHODS Eligible studies were identified from MedLine, PubMed, Embase, Web of Science, and Cochrane Library between Jan 1, 1980 and Sep 30, 2022. Outcome indicators were SPSS prevalence, liver function, decompensated events, and overall survival (OS). RESULTS Totally, 2015 studies were reviewed, of which 19 studies recruiting 6884 patients were included. On pooled analysis, the prevalence of SPSS was 34.2% (26.6%∼42.1%). SPSS patients had significantly higher Child-Pugh scores and grades and Model for End-stage Liver Disease scores (all P<0.05). Moreover, SPSS patients experienced a higher incidence of decompensated events, including hepatic encephalopathy, portal vein thrombosis, and hepatorenal syndrome (all P<0.05). Additionally, SPSS patients had significantly shorter OS than the non-SPSS group (P<0.05). CONCLUSIONS In patients with cirrhosis, SPSS outside the esophago-gastric region is common, characterized by severe impairment of liver function, high rates of decompensated events, including HE, PVT, and hepatorenal syndrome, as well as a high mortality rate.
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Affiliation(s)
- Qiao Ke
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 420, Fuma Road, Fuzhou, Fujian 350014, China; Department of Hepatopancreatobiliary Surgery, Clinical Oncology School of Fujian Medical University, No. 312, Xihong Road, Fuzhou, Fujian 350025, China
| | - Jian He
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 420, Fuma Road, Fuzhou, Fujian 350014, China
| | - Xinhui Huang
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 420, Fuma Road, Fuzhou, Fujian 350014, China
| | - Ling Li
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 420, Fuma Road, Fuzhou, Fujian 350014, China
| | - Jingfeng Liu
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 420, Fuma Road, Fuzhou, Fujian 350014, China; Department of Hepatopancreatobiliary Surgery, Clinical Oncology School of Fujian Medical University, No. 312, Xihong Road, Fuzhou, Fujian 350025, China.
| | - Wuhua Guo
- Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, No. 420, Fuma Road, Fuzhou, Fujian 350014, China.
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A Challenging Case of Refractory Hepatic Encephalopathy in a Postliver Retransplant Patient with Thrombosed Portal Vein: A Shunt for a Shunt. Case Reports Hepatol 2023; 2023:6765788. [PMID: 36879946 PMCID: PMC9985502 DOI: 10.1155/2023/6765788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/27/2023] Open
Abstract
Hepatic encephalopathy (HE) is a frequent and serious complication of chronic liver disease. The mechanism of hepatic encephalopathy is not entirely clear. Hepatic encephalopathy is defined as brain dysfunction caused by liver insufficiency and/or portal-systemic blood shunting. It manifests as a wide spectrum of neurological or psychiatric abnormalities, ranging from subclinical alterations, detectable only by neuropsychological or neurophysiological assessment, to coma. Liver transplant (LT) is the definitive treatment for refractory hepatic encephalopathy. In this case, we present a challenging case of refractory hepatic encephalopathy in a postliver transplant patient with portal vein thrombosis and a splenorenal shunt treated with a novel technique to address his complex anatomy.
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