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Shunt occlusion for portosystemic shunt syndrome related refractory hepatic encephalopathy-A single-center experience in 21 patients from Kerala.

Authors
  • Philips, Cyriac Abby1
  • Kumar, Lijesh2
  • Augustine, Philip3
  • 1 Department of Hepatology and Liver Transplant Medicine, PVS Memorial Hospital, Kochi, 682 025, India. [email protected] , (India)
  • 2 Department of Diagnostic and Interventional Radiology, PVS Memorial Hospital, Kochi, 682 025, India. , (India)
  • 3 Department of Gastroenterology, PVS Memorial Hospital, Kochi, 682 025, India. , (India)
Type
Published Article
Journal
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Publication Date
Sep 01, 2017
Volume
36
Issue
5
Pages
411–419
Identifiers
DOI: 10.1007/s12664-017-0787-8
PMID: 29124669
Source
Medline
Keywords
License
Unknown

Abstract

Between October 2016 and July 2017, 21 patients (Child-Pugh score, CTP 6 to 13) with mean model of end-stage liver disease (MELD) and MELD-sodium scores 15.7 and 19.3 respectively with MRHE [3-cirrhotic Parkinsonism (CP)] were diagnosed to have single or multiple large SPSSs. A total of 29 shunts were occluded (1 surgical, 20 non-surgical). Recurrent and persistent HE and CP markedly improved in the short (n=20, 1 to 3 months), intermediate (n=12, 3 to 6 months), and long (n=7, 6 to 9 months) follow up. None had spontaneous or persistent HE at a median follow up 105 (30 to 329) days (p<0.05). Motor, speech, sleep abnormalities, daily activities of living, and liver disease severity scores improved significantly on follow up. Baseline arterial ammonia showed a statistically significant reduction in all time periods of follow up after shunt occlusion (p<0.05). CTP >11 predicted mortality post shunt occlusion (p=0.04). Embolization of large SPSS in liver disease patients with MRHE and modestly preserved liver function is safe and efficacious and associated with improved quality of life and can function as a bridge to liver transplantation in accurately selected patients.

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