title: Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: a multicenter survey on safety and efficacy.
abstract: Refractory hepatic encephalopathy (HE) remains a major cause of morbidity in cirrhosis patients. Large spontaneous portosystemic shunts (SPSSs) have been previously suggested to sustain HE in these patients. We aimed to retrospectively assess the efficacy and safety of patients treated with embolization of large SPSSs for the treatment of chronic therapy-refractory HE in a European multicentric working group and to identify patients who may benefit from this procedure. Between July 1998 and January 2012, 37 patients (Child A6-C13, MELD [Model of Endstage Liver Disease] 5-28) with refractory HE were diagnosed with single large SPSSs that were considered eligible for embolization. On a short-term basis (i.e., within 100 days after embolization), 22 out of 37 patients (59.4%) were free of HE (P < 0.001 versus before embolization) of which 18 (48.6% of patients overall) remained HE-free over a mean follow-up period of 697 ± 157 days (P < 0.001 versus before embolization). Overall, we noted improved autonomy, decreased number of hospitalizations, and severity of the worst HE episode after embolization in three-quarters of the patients. Logistic regression identified the MELD score as strongest positive predictive factor of HE recurrence with a cutoff of 11 for patient selection. As to safety, we noted one major nonlethal procedure-related complication. There was no significant increase in de novo development or aggravation of preexisting varices, portal hypertensive gastropathy, or ascites.
  
  
  CONCLUSIONS
  This multicenter European cohort study demonstrated a role for large SPSSs in chronic protracted or recurrent HE and substantiated the effectiveness and safety of embolization of these shunts, provided there is sufficient functional liver reserve.
authors: Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium. wim.laleman@uzleuven.be
authors: Wim
authors: W
authors: Laleman
authors: Macarena
authors: M
authors: Simon-Talero
authors: Geert
authors: G
authors: Maleux
authors: Mercedes
authors: M
authors: Perez
authors: Koen
authors: K
authors: Ameloot
authors: German
authors: G
authors: Soriano
authors: Jordi
authors: J
authors: Villalba
authors: Juan-Carlos
authors: JC
authors: Garcia-Pagan
authors: Marta
authors: M
authors: Barrufet
authors: Rajiv
authors: R
authors: Jalan
authors: Jocelyn
authors: J
authors: Brookes
authors: Evangelos
authors: E
authors: Thalassinos
authors: Andrew K
authors: AK
authors: Burroughs
authors: Juan
authors: J
authors: Cordoba
authors: Frederik
authors: F
authors: Nevens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006501:Hepatic Encephalopathy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome