Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy

Keith Pereira, Andres F. Carrion, Paul Martin, Kirubahara Vaheesan, Jason Salsamendi, Mehul Doshi, Jose Yrizarry

Research output: Contribution to journalReview article

26 Scopus citations

Abstract

Transjugular intrahepatic portosystemic shunt has evolved into an important option for management of complications of portal hypertension. The use of polytetrafluoroethylene covered stents enhances shunt patency. Hepatic encephalopathy (HE) remains a significant problem after TIPS placement. The approach to management of patients with refractory hepatic encephalopathy typically requires collaboration between different specialties. Patient selection for TIPS requires careful evaluation of risk factors for HE. TIPS procedure-related technical factors like stent size, attention to portosystemic pressure gradient reduction and use of adjunctive variceal embolization maybe important. Conservative medical therapy in combination with endovascular therapies often results in resolution or substantial reduction of symptoms. Liver transplantation is, however, the ultimate treatment.

Original languageEnglish (US)
Pages (from-to)2487-2494
Number of pages8
JournalLiver International
Volume35
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • Hepatic encephalopathy
  • Portal hypertension
  • Spontaneous portosystemic shunt
  • Transjugular intrahepatic portosystemic shunt

ASJC Scopus subject areas

  • Hepatology

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