Z Gastroenterol 2020; 58(01): e18-e19
DOI: 10.1055/s-0039-3402149
Poster Visit Session II Clinical Hepatology, Surgery, LTX: Friday, February 14, 2020, 2:40 pm – 3:25 pm, Lecture Hall P1
Georg Thieme Verlag KG Stuttgart · New York

Predictive parameters and effectiveness of TIPS reduction in treatment of hepatic encephalopathy after TIPS

LL Seifert
1   Universitätsklinikum Münster, Medizinische Klinik B für Gastroenterologie und Hepatologie, Münster, Germany
,
P Schindler
2   Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Germany
,
M Köhler
2   Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Germany
,
A Riegel
2   Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Germany
,
M Masthoff
2   Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Germany
,
M Wildgruber
2   Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Germany
,
H Heinzow
1   Universitätsklinikum Münster, Medizinische Klinik B für Gastroenterologie und Hepatologie, Münster, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2020 (online)

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Question:

Aim of this retrospective study was to analyze the effectiveness of technical and clinical success of transjugular intrahepatic portosystemic shunt (TIPS) reduction for the treatment of hepatic encephalopathy (HE) after TIPS procedure. We further aimed to find predictive parameters for the development of HE in patients receiving TIPS.

Methods:

We analyzed data of 93 patients who received a TIPS at University Medical Center of Münster of which 45 patients developed HE after TIPS and 48 patients did not. 44% of patients who had developed HE after TIPS received TIPS reduction for the treatment of HE. We classified patients as responders to TIPS reduction if they achieved at least one stage improvement of HE according to West Haven Criteria. Patients who did not achieve at least one stage improvement were classified as non-responders.

Results:

Technical success rate of TIPS reduction was 100%. Mean increase of portosystemic pressure gradient (PPG) was 5 mmHg [7 mmHg (1 – 17) to 12 mmHg (6 – 21)]. Treatment of HE via TIPS reduction was successful in 55% of patients (responders). Recurrence of refractory ascites or variceal-bleeding requiring treatment was not observed. Six-month mortality rate was 33.3% in non-responders and only 9.1% in responders to TIPS reduction. High stage of HE was identified as a positive predictive variable for treatment success of HE via TIPS reduction. Increased serum creatinine levels after TIPS procedure, high INR as well as older patient age were identified as independent variables for development of HE after TIPS procedure.

Conclusion:

TIPS reduction is a safe and potent procedure for treatment of HE after TIPS. Patients with higher stage of HE can profit from TIPS reduction, independent from PPG. Serum creatinine level, high INR and patient age should further be considered as predictive variables for development of HE after TIPS procedure and deserve attention in the selection of patients eligible for TIPS.