QJM Advance Access originally published online on April 25, 2008
QJM 2008 101(6):493-501; doi:10.1093/qjmed/hcn037
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Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt insertion: a decade of experience
From the 1Liver Unit and 2Department of Radiology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
Address correspondence to Steven Masson, The Liver Unit, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK. email: steven_masson{at}hotmail.com
Received 9 April 2007 and in revised form 12 September 2007
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Abstract |
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Background: Since its introduction, transjugular intrahepatic portosystemic shunt (TIPS) has been extensively used for treatment of portal hypertension. We report a decade of experience with particular emphasis on characterizing post-TIPS hepatic encephalopathy (HE).
Aim: To determine the frequency of clinically evident or minimal HE post-TIPS, identify predisposing factors and determine the impact of minimal HE on quality of life.
Design: Prospective data collection and retrospective case notes analysis.
Methods: Of 197 patients referred for TIPS insertion, 136 patients who survived the procedure by more than 4 weeks were available for assessment. Data collected at TIPS insertion was supplemented by case note analysis. Psychometric testing was performed and health profile questionnaires administered on patients still attending.
Results: Most patients had alcoholic liver disease (62.4%) and bleeding varices unresponsive to endoscopic therapy (86%). Clinically evident post-TIPS HE developed in 34.5% of patients, was of similar frequency in the groups treated with polytetrafluoroethylene covered and uncovered stents, and the only significant predictor was pre-TIPS HE. Post-TIPS HE necessitating liver transplant or contributing to death occurred in only 14 (10.3%) patients. Minimal encephalopathy (abnormal psychometry) was present in 49% of patients at 26 (3–123) months after TIPS but this frequency was similar in a cohort of cirrhotics being assessed for liver transplant. However, patients with abnormal psychometry had significantly lower quality of life scores than those with normal psychometry.
Conclusions: Although, HE is relatively common after TIPS insertion, with careful selection of patients it is usually short-lived and easily managed. Minimal HE is no more prevalent than expected in a cirrhotic population without TIPS.