Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy

Liver International : Official Journal of the International Association for the Study of the Liver
Keith PereiraJose M Yrizarry

Abstract

Transjugular intrahepatic portosystemic shunt has evolved into an important option for management of complications of portal hypertension. The use of polytetrafluoroethylene covered stents enhances shunt patency. Hepatic encephalopathy (HE) remains a significant problem after TIPS placement. The approach to management of patients with refractory hepatic encephalopathy typically requires collaboration between different specialties. Patient selection for TIPS requires careful evaluation of risk factors for HE. TIPS procedure-related technical factors like stent size, attention to portosystemic pressure gradient reduction and use of adjunctive variceal embolization maybe important. Conservative medical therapy in combination with endovascular therapies often results in resolution or substantial reduction of symptoms. Liver transplantation is, however, the ultimate treatment.

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Citations

Jul 6, 2016·Scandinavian Journal of Gastroenterology·Mingyan ZhangChunqing Zhang
Apr 19, 2018·Journal of Pediatric Gastroenterology and Nutrition·Lauren C JohansenSimon P McGuirk
May 22, 2020·Cardiovascular and Interventional Radiology·Wendy Melissa CoronadoBaljendra Kapoor
Aug 7, 2018·Canadian Journal of Gastroenterology & Hepatology·Hong-Bin LiFu-Quan Liu
Oct 3, 2019·World Journal of Gastroenterology : WJG·Xiao-Yuan XuChinese Medical Association
Nov 27, 2020·Journal of Clinical Medicine·Philipp SchindlerMoritz Wildgruber
Oct 17, 2020·Therapeutic Advances in Gastroenterology·Judit Vidal-GonzálezJoan Genescà

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