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Review article: post-TIPSS hepatic encephalopathy-current knowledge and future perspectives.

Simon Johannes Gairing1,2, Lukas Müller3, Roman Kloeckner3

  • 1Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.

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Transjugular intrahepatic portosystemic shunts (TIPSS) can cause hepatic encephalopathy (HE) in up to 54.5% of patients. Careful patient selection and new treatments like rifaximin may help prevent this severe complication.

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Area of Science:

  • Hepatology
  • Interventional Radiology
  • Gastroenterology

Background:

  • Chronic liver diseases and cirrhosis are increasing globally, leading to more decompensation events.
  • Transjugular intrahepatic portosystemic shunts (TIPSS) effectively manage portal hypertension complications like ascites and variceal bleeding.
  • Hepatic encephalopathy (HE) after TIPSS (post-TIPSS HE) is a severe complication impacting patient outcomes.

Purpose of the Study:

  • To investigate the epidemiology and risk factors of post-TIPSS HE.
  • To review current treatment and drug therapy options for post-TIPSS HE.
  • To inform clinical practice regarding TIPSS candidate selection and management.

Main Methods:

  • A literature search was conducted focusing on post-TIPSS HE in patients with liver cirrhosis.
  • Narrative review methodology was employed to synthesize existing evidence.

Main Results:

  • Post-TIPSS HE affects up to 54.5% of patients, with early recurrence indicating a poor prognosis.
  • Identified risk factors include liver function scores (MELD/Child-Pugh), minimal HE, sarcopenia, and proton pump inhibitor use.
  • Emerging data suggest benefits from rifaximin and smaller stent grafts for prevention.

Conclusions:

  • Careful selection of TIPSS candidates is crucial to minimize the risk of post-TIPSS HE.
  • Understanding risk factors and available treatments is essential for managing post-TIPSS HE.
  • This review provides an overview of the current knowledge on post-TIPSS HE epidemiology, risk factors, and treatment.