Transjugular retrograde obliteration for chronic portosystemic encephalopathy

Area of Science:

• Interventional Radiology
• Hepatology
• Gastroenterology

Background:

• Chronic portosystemic encephalopathy (CPSE) is a rare complication of cirrhosis with undefined management strategies.
• Patients with CPSE often present with gastric varices and large gastrorenal shunts, contributing to hepatic encephalopathy.

Observation:

• Five patients with advanced cirrhosis (Child's class B/C) and severe hepatic encephalopathy underwent transjugular retrograde obliteration (TJO).
• The TJO procedure successfully obliterated gastrorenal shunts using absolute ethanol and ethanolamine oleate.
• Portal flow volume significantly increased post-TJO, alongside substantial reductions in plasma ammonia levels and improved liver function markers.

Findings:

• All five patients experienced complete resolution of hepatic encephalopathy (grade 0) following TJO.
• Significant improvements were observed in portal hemodynamics and biochemical markers of liver function.
• Minor complications included transient fever and hemorrhagic gastritis; one patient died from hepatocellular carcinoma unrelated to the procedure.

Implications:

• Transjugular retrograde obliteration (TJO) presents a safe and effective therapeutic option for managing chronic portosystemic encephalopathy.
• This interventional technique offers a viable alternative for patients with CPSE refractory to conventional treatments.
• Successful shunt obliteration via TJO can lead to sustained improvement in neurological status and liver function in cirrhotic patients.