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
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.
Authors
Correspondence to:
Marcus Allen Healey, Department of Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA Marcus.Healey@vcuhealth.org
Publication history:
Received 18 Nov 2022
Accepted 01 Feb 2023
Published online 16 Feb 2023
Published in print 07 Mar 2023
Healey MA, Duong N, Patel K, Strife B, Sterling RK. Transjugular intrahepatic portosystemic shunt reduction for refractory hepatic encephalopathy: a case series. EJMCR. 2023; 7(3): 70-74. doi:
10.24911/ejmcr/173-1668794112
Healey MA, Duong N, Patel K, Strife B, Sterling RK. Transjugular intrahepatic portosystemic shunt reduction for refractory hepatic encephalopathy: a case series. https://www.ejmcr.com/?mno=130987 [Access: April 17, 2024]. doi:
10.24911/ejmcr/173-1668794112
Healey MA, Duong N, Patel K, Strife B, Sterling RK. Transjugular intrahepatic portosystemic shunt reduction for refractory hepatic encephalopathy: a case series. EJMCR. 2023; 7(3): 70-74. doi:
10.24911/ejmcr/173-1668794112
Healey MA, Duong N, Patel K, Strife B, Sterling RK. Transjugular intrahepatic portosystemic shunt reduction for refractory hepatic encephalopathy: a case series. EJMCR. (2023), [cited April 17, 2024]; 7(3): 70-74. doi:
10.24911/ejmcr/173-1668794112
Healey, M. A., Duong, . N., Patel, . K., Strife, . B. & Sterling, . R. K. (2023) Transjugular intrahepatic portosystemic shunt reduction for refractory hepatic encephalopathy: a case series. EJMCR, 7 (3), 70-74. doi:
10.24911/ejmcr/173-1668794112
Healey, Marcus Allen, Nikki Duong, Kunal Patel, Brian Strife, and Richard K. Sterling. 2023. Transjugular intrahepatic portosystemic shunt reduction for refractory hepatic encephalopathy: a case series. European Journal of Medical Case Reports, 7 (3), 70-74. doi:
10.24911/ejmcr/173-1668794112
Healey, Marcus Allen, Nikki Duong, Kunal Patel, Brian Strife, and Richard K. Sterling. "Transjugular intrahepatic portosystemic shunt reduction for refractory hepatic encephalopathy: a case series." European Journal of Medical Case Reports 7 (2023), 70-74. doi:
10.24911/ejmcr/173-1668794112
Healey, Marcus Allen, Nikki Duong, Kunal Patel, Brian Strife, and Richard K. Sterling. "Transjugular intrahepatic portosystemic shunt reduction for refractory hepatic encephalopathy: a case series." European Journal of Medical Case Reports 7.3 (2023), 70-74. Print. doi:
10.24911/ejmcr/173-1668794112
Healey, M. A., Duong, . N., Patel, . K., Strife, . B. & Sterling, . R. K. (2023) Transjugular intrahepatic portosystemic shunt reduction for refractory hepatic encephalopathy: a case series. European Journal of Medical Case Reports, 7 (3), 70-74. doi:
10.24911/ejmcr/173-1668794112