Efficacy of puncturing different portal vein branch during transjugular intrahepatic portosystemic shunt with 8 mm covered stent: a propensity-score analysis. Issue 8 (19th September 2020)

• Record Type: Journal Article
• Authors: Zhou, Yongjie; Ma, Jingqin; Ju, Shuai; Zhang, Zihan; Zhang, Wen; Yang, Minjie; Zhou, Xin; Yan, Zhiping; Luo, Jianjun
• Is Part Of: European journal of gastroenterology & hepatology. Volume 33:Issue 8(2021)
• Page Start: 1110
• Page End: 1116
• Publication Date: 2020-09-19
• Subjects: hepatic encephalopathy -- portal hypertension -- propensity-score analysis -- transjugular intrahepatic portosystemic shunt -- variceal bleeding; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000002133
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Background: Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) remains an unsolved problem; therefore, this study aimed to compare the efficacy of shunting different portal vein branch during TIPS with 8 mm covered stent for preventing gastroesophageal variceal rebleeding in cirrhotic patients. Methods: Between November 2015 and December 2018, the medical records of consecutive cirrhotic patients who received TIPS with an 8 mm covered stent for preventing gastroesophageal variceal rebleeding were analyzed retrospectively. Shunting the left and right branches of the portal vein was performed in 58 (group A) and 104 patients (group B), respectively. Afterwards, 54 patients in each group were produced by the PSM method. The incidence of overt hepatic encephalopathy (OHE), shunt patency, variceal rebleeding and survival were compared between two groups by using Kaplan–Meier analysis and log-rank test. Results: The median follow-up time was 37 months (range 0.3–50 months). The 6-, 12- and 24-months cumulative OHE free rates in groups A and B were 92.5, 86.2, 83.6% and 74.1, 70.2, 67.6%, respectively ( P = 0.042; hazard ratio = 0.469; 95% CI, 0.223–0.988). Two (3.7%) and eight (14.8%) patients experienced severe OHE in groups A and B, respectively ( P = 0.042). There were no significant differences between the two groups in terms of shunt patency, variceal rebleeding and survival. Conclusion: Shunting the left portal vein branch during TIPS with an 8 mm covered stent for preventing gastroesophageal variceal rebleeding in cirrhotic patients might decrease the occurrence of OHE significantly. The prospective trial is needed to further provide evidence of this results in future.