Whether Gastrorenal Shunt Embolization Would Benefit the Outcomes of Post Transjugular Intrahepatic Portosystemic Shunt
Abstract Background & Aim: Whether the spontaneous portosystemic shunts in cirrhosis who require embolization during transjugular intrahepatic portosystemic shunt (TIPS) remains a therapeutic controversial. This study was retrospectively conducted to evaluate the effectiveness of the gastrorenal shunts (GRS) embolization in cirrhosis post-TIPS。Methods: 70 cirrhotic patients who underwent TIPS in a tertiary-care center were included, of which 43 patients had no GRS and 27 had GRS with embolization during TIPS placement. Then, to assess the outcomes of embolization of GRS on post-TIPS hepatic encephalopathy (HE), clinical relapse, mortality and shunt dysfunction.Results: During a median follow-up period of 497.01 days, 25 patients (35.7%) experienced HE, of 14 patients in GRS group and 11 in another (p = 0.026). Within 50 days after TIPS, 12 patients performed initial HE in GRS group while 6 in the reference group (p < 0.001). After TIPS of 150th to 200th, one in the former group and five in another experienced HE (p < 0.001). However, there was no significant difference in the 1-year cumulative risk of HE (p = 0.287). Meanwhile, during the 2-year follow-up, the patients performed lower incidence of ascites after GRS embolization with TIPS (p < 0.002). And there was no difference in rebleeding, mortality and shunt dysfunction. Conclusions: TIPS with GRS embolization appeared to be a safe and efficacious procedure in the treatment of portal hypertension with concomitant GRS. Furthermore, the procedure seemed to reduce the recurrences of ascites for a long term observation.