title: Long term results of balloon-occluded retrograde transvenous obliteration for portosystemic shunt encephalopathy in patients with liver cirrhosis and portal hypertension.
abstract: This study examined 19 patients with portosystemic shunt encephalopathy caused by a splenorenal shunt (SRS), which was treated with balloon-occluded retrograde transvenous obliteration (B-RTO). Long-term treatment outcomes were evaluated based on hepatic functional reserve and vital prognosis. Encephalopathy improved in all patients after shunt embolization and closure. Albumin, serum ammonia, and the Child-Pugh score, a measure of liver function, were significantly improved 3 years after B-RTO, and exacerbation of damage to liver function was avoided (p<0.01). During the follow-up period, three patients died from liver failure and two patients from hepatocellular carcinoma. Patients had a poor prognosis if their albumin levels were less than 2.8 mg / dL before B-RTO (p<0.05). Encephalopathy patients had complete response to B-RTO, but long-term prognosis was affected by hepatic functional reserve before B-RTO and by concurrent hepatocellular carcinoma. The results of this study suggest that in patients with SRS, it is important to perform B-RTO at an early stage when the hepatic functional reserve is still satisfactory.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Inoue
authors.forename: Keigo
authors.initials: K
authors.lastname: Emori
authors.forename: Atsushi
authors.initials: A
authors.lastname: Toyonaga
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Oho
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kumamoto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Haruta
authors.forename: Keiichi
authors.initials: K
authors.lastname: Mitsuyama
authors.forename: Osamu
authors.initials: O
authors.lastname: Tsuruta
authors.forename: Michio
authors.initials: M
authors.lastname: Sata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000009:adverse effects / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D017093:Liver Failure / Q000209:etiology / Q000401:mortality; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015911:Sclerotherapy / Q000009:adverse effects / Q000401:mortality; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D000075462:Serum Albumin, Human