Intractable hepatic encephalopathy in cirrhotic patients: mid-term efficacy of balloon-occluded retrograde portosystemic shunt obliteration.
Purpose: To evaluate the efficacy and intermediate-term outcome of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hepatic encephalopathy (HE) secondary to portosystemic shunt (PSS) in cirrhotic patients.Materials and Methods: Institutional review board (IRB) approva...
| Publicado en: | European Radiology Vol. 30; no. 6; pp. 3462 - 3473 |
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| Autores principales: | , , , , |
| Formato: | research Journal Article |
| Publicado: |
Springer Nature
Jun2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=143397281&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 143397281 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09387994 NPH jtl: European Radiology issn: 09387994 maglogo: N pubinfo: dt: Jun2020 vid: 30 iid: 6 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 143397281 143397281 NLM32048037 143397281 10.1007/s00330-019-06644-4 NLM32048037 143397281 ppf: 3462 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Intractable hepatic encephalopathy in cirrhotic patients: mid-term efficacy of balloon-occluded retrograde portosystemic shunt obliteration. aug: au: Mukund, Amar Chalamarla, Lakshmi Kumar Singla, Nishant Shasthry, Saggere Muralikrishna Sarin, Shiv Kumar affil: Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, 110070, New Delhi, India sug: subj: Balloon Dilatation Methods Hypertension, Portal Complications Sclerosing Solutions Therapeutic Use Hepatic Encephalopathy Therapy Liver Cirrhosis Complications Splenic Vein Recurrence Survival Retrospective Design Female Renal Veins Tomography, X-Ray Computed Adult Esophageal and Gastric Varices Etiology Middle Age Treatment Outcomes Male Hepatic Encephalopathy Etiology Aged Human Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Female Male ab: Purpose: To evaluate the efficacy and intermediate-term outcome of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hepatic encephalopathy (HE) secondary to portosystemic shunt (PSS) in cirrhotic patients.Materials and Methods: Institutional review board (IRB) approval was obtained for this study and hospital records of patients who underwent BRTO, from August 2011 to August 2015, were analyzed. Based on the inclusion and exclusion criteria, 39 patients (age, 54.07 ± 9.1 years (37-67 years); 33 males and 6 females) with cirrhosis and spontaneous PSS were included. Clinical and laboratory parameters and HE grade were evaluated in all patients before and after the procedure.Results: Forty sessions of BRTO were attempted in 39 patients. Follow-up imaging revealed complete obliteration of the treated PSS in all patients with clinical success in 37 patients (94.9%). The 1-, 2-, 3-, 4-, 5-, 6-, and 7-year HE-free survival rates among responders were 91.7%, 91.7%, 88.8%, 85.5%, 80.8%, 80.8%, and 80.8% respectively and overall survival rates were 89.7%, 82.1%, 76.9%, 74.4%, 74.4%, 64.8%, and 64.8% respectively. Logistic regression highlighted Child-Turcotte-Pugh (CTP) score at 6 months as a positive predictive factor of HE recurrence with a cutoff of ≥ 9. Five patients (12.8%) had fever and leukocytosis and 1 (2.6%) patient developed spontaneous bacterial peritonitis after the procedure.Conclusion: BRTO is an effective treatment for refractory HE in cirrhotics secondary to large PSS with a few possible complications.Key Points: • BRTO is an effective and safe treatment for refractory HE, arising from PSS in cirrhotic patients. • Patients with preserved liver function show better outcome and CTP score is the most important predictor of relapse during follow-up. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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