دورية أكاديمية
TIPSS modification in the management of post TIPSS refractory hepatic encephalopathy
| العنوان: | TIPSS modification in the management of post TIPSS refractory hepatic encephalopathy |
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| المؤلفون: | Kochar, Narendra, Tripathi, Dhiraj, Ireland, Hamish, Redhead, Doris N, Hayes, Peter C |
| بيانات النشر: | BMJ Publishing Group Ltd |
| سنة النشر: | 2006 |
| المجموعة: | HighWire Press (Stanford University) |
| مصطلحات موضوعية: | Paper |
| الوصف: | Background: Post TIPSS hepatic encephalopathy (HE) can occur in up to a third of patients. In 5%, this can be refractory to optimal medical treatment and may require shunt modification. The efficacy of shunt modification has been little studied. Aims: To evaluate the efficacy of and natural history following TIPSS modification for treatment of refractory HE. Methods: From a dedicated database, we selected and further studied patients who had TIPSS modification for refractory HE. Results: Over a 14-year period, of 733 TIPSS insertions, 211(29%) patients developed HE post-TIPSS. In 38 patients, shunt modification {reduction (n=9) and occlusion (n=29)} was performed for refractory HE. Indications for TIPSS: Variceal bleeding (n=32), refractory ascites (n=5) and other (n=1). Child' grade: A/B/C, 11%/47%/42%. HE improved in 58%, and remained unchanged or worsened in 42%, with similar results for occlusions and reductions. Following shunt modification variceal bleeding recurred in 3, and ascites in 3. 25 patients have died (liver related in 15) at a median duration of 10.2 months. 3 patients died due to procedure related complications following shunt occlusions (mesenteric infarction in 2, septicaemia in 1). Median survival of patients whose HE did not improve following shunt modification was 79 days compared with 278 days in patients whose did (p<0.05). No variables independently predicted response to shunt modification. Conclusions: TIPSS modification is a useful option for patients with refractory HE following TIPSS insertion. Due to significant risk of iatrogenic complications with shunt occlusions, shunt reduction is a safer and preferred option. |
| نوع الوثيقة: | text |
| وصف الملف: | text/html |
| اللغة: | English |
| العلاقة: | http://gut.bmj.com/cgi/content/short/gut.2005.089482v1Test; http://dx.doi.org/10.1136/gut.2005.089482Test |
| DOI: | 10.1136/gut.2005.089482 |
| الإتاحة: | https://doi.org/10.1136/gut.2005.089482Test http://gut.bmj.com/cgi/content/short/gut.2005.089482v1Test |
| حقوق: | Copyright (C) 2006, BMJ Publishing Group |
| رقم الانضمام: | edsbas.6B2288E6 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1136/gut.2005.089482 |
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