Chronic liver disease and cirrhosis (scarring of the liver) are major causes of morbidity and mortality worldwide. Chronic liver disease causes approximately 1.32 million deaths per year. Cirrhosis is the 11th leading cause of death and 15th leading cause of morbidity, accounting for 2.2% of deaths in the world.
A spontaneous portosystemic shunt (SPSS) is a rare malformation of the vessels supplying the liver that can lead to the development of hepatic encephalopathy due to excessive shunting of blood from the portal vein to the inferior vena cava.
Liver disease can be a serious condition, and sometimes it requires treatment that involves a procedure called transjugular intrahepatic portosystemic shunt (TIPS). While TIPS can be effective, one of the complications that may arise from the procedure is overt hepatic encephalopathy (OHE). OHE is a condition where brain function is affected due to the accumulation of toxins in the body, resulting from liver damage.
A clinical trial investigates the benefit of SPSS embolization before the transjugular intrahepatic portosystemic shunt (TIPS) procedure in the prevention of hepatic encephalopathy.
Clinical Trial
The trial has shown that concurrent large spontaneous portosystemic shunt embolization can prevent OHE after TIPS.The clinical trial, which was published in the journal Hepatology, involved 56 patients with cirrhosis and large SPSS planning to undergo TIPS for the prevention of variceal bleeding. The patients were randomly assigned to receive either TIPS alone or TIPS with concurrent SPSS embolization. The primary outcome of the study was to compare the incidence of OHE between the two groups.
The results of the trial showed that the group of patients who received TIPS with concurrent SPSS embolization had a significantly lower incidence of OHE at 24 months compared to the group of patients who received TIPS alone. Specifically, the incidence of OHE was 21.2% in the TIPS with SPSS embolization group, compared to 48.3% in the TIPS alone group.
In addition to the primary outcome, the study also looked at other secondary outcomes. The incidence of recurrent bleeding, shunt dysfunction, and death was not significantly different between the two groups.
Implications
The clinical research is significant because it suggests that concurrent SPSS embolization may be an effective method for preventing OHE after TIPS. OHE is a serious complication that can lead to neurological impairment and even death in severe cases. By reducing the incidence of OHE, patients may have a better overall outcome and a lower risk of long-term complications.Conclusion
The clinical trial provides evidence that concurrent SPSS embolization may be a safe and effective method for preventing OHE after TIPS. This is an important finding that may improve outcomes for patients with liver disease who require a TIPS procedure. As always, it's important to discuss any questions or concerns about your medical treatment with your healthcare provider.__________
AASLD Hepatology, Sep-22