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Embolization of spontaneous portosystemic shunt improves survival with recurrent hepatic encephalopathy

Improvement in survival is associated with embolization of spontaneous portosystemic shunt in patients with recurrent hepatic encephalopathy, reports June's issue of the Alimentary Pharmacology & Therapeutics.

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Spontaneous portosystemic shunt (SPSS) is a frequent cause of recurrent hepatic encephalopathy (HE) in patients with cirrhosis.

Professor Lim and colleagues from Korea assessed the effectiveness and optimal candidate selection for embolization of SPSS, for the treatment of recurrent HE in patients with cirrhosis.

The team performed a retrospective cohort study comparing 17 patients with recurrent HE who achieved complete occlusion of SPSS by angiographic embolisation, and 17 control patients.

Most baseline characteristics were similar in the 2 groups.

The team found that the 2-year HE recurrence rate was significantly lower in the embolization than in the control group, whereas their 2-year overall survival rates were similar.

Model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) score were significant predictors of 2-year patient mortality in the embolization group.

Analysis of patients with MELD <15 in the absence of hepatocellular carcinoma (HCC) showed that 2-year overall survival rate was significantly higher in the embolization group than in the control group.

The team demonstrated that the median changes in MELD, CTP score, and liver volume at 1 year significantly favored the embolization group.

Serious clinical complications after embolization occurred only in patients who had MELD ≥15 and/or HCC at baseline, with all 6 dying within 1 year.

Professor Lim and colleagues conclude, "Embolization of a large spontaneous portosystemic shunt may be associated with improved survival and liver function, as well as prevention of hepatic encephalopathy in cirrhotic patients with recurrent hepatic encephalopathy, and modestly preserved liver function."

Aliment Pharmacol Ther 2014: 39(12): 1418–1426
30 May 2014

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