Efficacy and Safety of Spontaneous Portosystemic Shunts Embolization for Hepatic Encephalopathy: A Meta-analysis

Spontaneous portosystemic shunt (SPSS) embolization represents a promising intervention for refractory hepatic encephalopathy (HE). This systematic review and meta-analysis evaluate the efficacy and safety of SPSS embolization in cirrhotic patients without transjugular intrahepatic portosystemic shunts (TIPS).

We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library through June 12, 2024 to identify studies investigating SPSS embolization for HE. Meta-analysis was performed using fixed-effect or random-effects models to calculate clinical success (defined as HE remission), procedural success rates, and complication frequencies.

Analysis of 10 retrospective studies encompassing 289 cirrhotic patients yielded the following pooled outcomes: hepatic encephalopathy remission rate of 83.1% (95% CI: 70.4%-93.1%), procedural success rate of 99.8% (95% CI: 98.3%-100%), and long-term adverse event rate of 42.9% (95% CI: 34.7%-51.4%). The predominant long-term complications included ascites (51.6% of complications), variceal progression (23.4%), and thrombosis (8.0%), while primary procedure-related adverse reactions were infection (37%) and fever (29%). Subgroup analyses demonstrated no statistically significant effect of etiology (p=0.788) or shunt type (p=0.271) on disease remission rates, but revealed significant differences between surgical approaches (p<0.001), with balloon-occluded retrograde transvenous obliteration (BRTO) showing the highest efficacy (97.4%-100%).

SPSS embolization demonstrates both high efficacy for refractory hepatic encephalopathy (83.1% remission rate) and exceptional procedural success (99.8%). Despite substantial long-term complications (42.9%, predominantly portal hypertension sequelae), current evidence from predominantly retrospective studies supports its consideration as a therapeutic option. Technique selection should be individualized pending further validation of BRTO's superiority.