Case Series
Volume: 7 | Issue: 3 | Published: Feb 16, 2023 | Pages: 70 - 74 | DOI: 10.24911/ejmcr/173-1668794112
Transjugular intrahepatic portosystemic shunt reduction for refractory hepatic encephalopathy: a case series
Authors: Marcus Allen Healey , Nikki Duong , Kunal Patel , Brian Strife , Richard K. Sterling
Article Info
Authors
Marcus Allen Healey
Department of Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
Nikki Duong
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
Kunal Patel
Division of Interventional Radiology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
Brian Strife
Division of Interventional Radiology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
Richard K. Sterling
Department of Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
Publication History
Received: November 18, 2022
Accepted:
Published: February 16, 2023
Abstract
Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a therapeutic intervention for refractory ascites and variceal bleeding. However, the development of hepatic encephalopathy (HE) is a known complication. TIPS diameter can be reduced to decrease further HE episodes when refractory to pharmacotherapy. However, TIPS reduction for refractory hepatic encephalopathy (rHE) is poorly described. This case series identifies various characteristics and outcomes among this unique patient cohort. Case Presentation: In this cohort of 8 patients, 63% were male, 75% were Caucasian, and 38% had alcohol-associated cirrhosis. Following TIPS reduction, the number of HE-related admissions (mean, median) decreased from 2.1 and 2 to 1.6 and 0.5 while the number of non-HE admissions following TIPS reduction increased from 0.6 and 0 to 1 and 0.5. Conclusion: TIPS reduction reduced the number of hospitalizations for rHE but the total number of hospitalizations for all causes increased, demonstrating the high resource utilization for those with rHE following TIPS. Therefore, careful selection for initial TIPS placement remains a priority.
Keywords: Transjugular intrahepatic portosystemic shunt (TIPS), refractory ascites (RA), variceal bleed (VB), refractory hepatic encephalopathy (rHE), case report, green
