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Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
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Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with

Marika Rudler1,2,3, Virginia Hernández-Gea4, Bogdan Dumitru Procopet5,6

  • 1Hepatology and gastroenterology, Unité de Soins Intensifs d'Hépato-Gastro-Entérologie, Groupement Hospitalier APHP-Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France, Paris, France marika_rudler@yahoo.fr.

Gut
|November 3, 2022
PubMed

Insights

Pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) improves survival in high-risk cirrhosis patients with acute variceal bleeding and hepatic encephalopathy (HE). This treatment is associated with better outcomes compared to endoscopic therapy, even with pre-existing HE.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Interventional Radiology

Background:

  • Pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) reduces mortality in high-risk cirrhosis patients with acute variceal bleeding (AVB).
  • Concerns about hepatic encephalopathy (HE) limit pTIPS use in eligible patients.
  • The outcomes of patients with HE undergoing pTIPS are not well-established.

Purpose of the Study:

  • To assess HE prevalence in patients with AVB.
  • To evaluate outcomes for patients with HE at admission undergoing pTIPS.
  • To determine if HE at admission is a risk factor for mortality and post-pTIPS HE.

Main Methods:

  • Observational study of 2138 patients across 34 centers (October 2011 - May 2015).
  • Follow-up for up to 1 year, including death or liver transplantation.
  • Comparison of pTIPS versus endoscopic+drug treatment in high-risk patients.

Main Results:

  • HE was more frequent in high-risk patients (39.2%) versus low-risk (10.6%).
  • In high-risk patients with HE at admission, pTIPS showed lower 1-year mortality (HR 0.374) than endoscopic+drug treatment.
  • HE incidence was similar between pTIPS and endoscopic+drug groups (38.2% vs 38.7%).
  • Independent risk factors for death included age >56, shock, MELD score >15, endoscopic+drug treatment, and HE at admission.

Conclusions:

  • pTIPS is associated with improved survival compared to endoscopic treatment in high-risk cirrhosis patients with variceal bleeding and HE at admission.
  • HE at admission does not preclude the survival benefit of pTIPS in this population.
Abstract

Keywords:
cirrhosishepatic encephalopathyoesophageal varices

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