Concurrent Spontaneous Portosystemic Shunt During TIPS Reduces Risk for HE

Patients with pre-existing spontaneous portosystemic shunt (SPSS) are at a significantly higher risk for post-transjugular intrahepatic portosystemic shunt (TIPS) overt hepatic encephalopathy (HE). However, concurrent embolization during TIPS procedure helps reduce the risk for overt HE without increasing risk for complications, according to study results published in Digestive and Liver Disease. 

Researchers conducted a systematic review and meta-analysis among patients with a confirmed diagnosis of cirrhosis who had a TIPS procedure. For the study, the researchers reported on the efficacy and safety of the prophylactic embolization of SPSS during TIPS creation. The primary outcomes assessed included the occurrence of overt HE in the included patients. The secondary outcomes assessed comprised rebleeding, mortality, and shunt dysfunction.

Among the 1330 identified records, a total of 4 studies comprising 1243 patients were included. Within the SPSS group, 114 individuals (46%) experienced overt HE, while in the non-SPSS group, 305 individuals (38.4%) exhibited overt HE after undergoing TIPS intervention.

In patients with SPSS, the occurrence of overt HE was notably high after TIPS intervention in the subgroup without SPSS embolization (odds ratio [OR], 2.41, 95% CI, 1.32-4.38; P =.004). The incidence of overt hepatic HE in the SPSS group demonstrated a significant increase after TIPS, which includes SPSS embolization and no treatment (OR, 1.44, 95% CI, 1.07-1.93; P =.01). Patients with SPSS without embolization, experienced a higher likelihood of developing overt HE following TIPS intervention compared with those without SPSS (OR, 1.64, 95% CI, 1.19-2.25; P =.002).

The collective findings suggest that there were no statistically significant differences in rebleeding rates following TIPS intervention between the SPSS and non-SPSS groups (0.94, 95% CI, 0.66-1.34; P =.74). These observations were consistent across all subgroup analyses.

Similarly, the overall morbidity rate did not differ between the SPSS and non-SPSS groups (0.79, 95% CI 0.58-1.07; P =.13). These observations were consistent across all subgroup analyses. Furthermore, the shunt dysfunction rate did not differ between individuals with SPSS treated with or without embolization (1.40, 95% CI 0.51-3.83; P =.51).

The findings of this study may be limited by the incorporation of cohorts from both randomized and nonrandomized studies, which took place in Asia, which may introduce bias and confounding.

“Concurrent embolization of the SPSS via the jugular vein during TIPS placement helps to reduce the increased risk of overt HE after TIPS and does not increase the risk of complications, including variceal rebleeding, shunt dysfunction and mortality,” study authors noted.

This article originally appeared on Gastroenterology Advisor