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Abstract Details
Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy : A multi-center survey on safety & efficacy
Laleman W, Simon-Talero M, Maleux G, Perez M, Ameloot K, Soriano G, Villalba J, Garcia-Pagan JC, Barrufet M, Jalan R, Brookes J, Thalassinos E, Burroughs AK, Cordoba J, Nevens F; on behalf of the EASL-CLIF-consortium. Hepatology. 2013 Feb 7. doi: 10.1002/hep.26314. [Epub ahead of print]
Source
Department of Liver and Biliopancreatic disorder, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium. wim.laleman@uzleuven.be.
Abstract
Refractory hepatic encephalopathy (HE) remains a major cause of morbidity in cirrhotic patients. Large spontaneous portosystemic shunts (SPSSs) have been previously suggested to sustain HE in these patients. We aimed to retrospectively assess the efficacy and safety of patients treated with embolization of large SPSSs for the treatment of chronic therapy-refractory HE in a European multicentric working group and to identify patients that may benefit from this procedure. Between July 1998 and January 2012, 37 patients (Child A6-C13, MELD 5-28) with refractory HE were diagnosed with single large SPSSs which were considered eligible for embolization. On a short-term basis (i.e. within 100 days after embolization), 22 out of 37 patients (59.4%) were free of HE (P<0.001 vs before embolization) of which 18 (48.6% of patients overall) remained HE-free over a mean period of follow-up of 697 ± 157 days (P<0.001 vs before embolization). Overall, we noted improved autonomy, decreased number of hospitalizations or severity of the worst HE episode after embolization in three quarters of the patients. Logistic regression identified the MELD-score as strongest positive predictive factor of HE recurrence with a cut-off of 11 for patient selection. As to safety, we noted 1 major non-lethal procedure-related complication. There was no significant increase in de novo development or aggravation of preexisting varices, portal hypertensive gastropathy or ascites.