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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Segmental intrahepatic cholestasis as a technical complication of the transjugular intrahepatic porto-systemic shunt
Julian Nikolaus Bucher, Marcus Hollenbach, Steffen Strocka, Gereon Gaebelein, Michael Moche, Thorsten Kaiser, Michael Bartels, Albrecht Hoffmeister
Julian Nikolaus Bucher, Department of Surgery, Munich University Hospital at Großhadern, Bavaria, Munich 81377, Germany
Marcus Hollenbach, Medical Department II–Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Saxony, Leipzig 04103, Germany
Steffen Strocka, Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Saxony, Leipzig 04103, Germany
Gereon Gaebelein, Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Saarland, Homburg 66421, Germany
Michael Moche, Department of Diagnostic and Interventional Radiology, Bavaria, Nuernberg 90411, Germany
Thorsten Kaiser, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center, Saxony, Leipzig 04310, Germany
Michael Bartels, Department for General and Visceral Surgery, Helios Park-Klinikum Leipzig, Saxony, Leipzig 04289, Germany
Albrecht Hoffmeister, Medical Department II–Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Leipzig 04103, Saxony, Germany
Author contributions: Bucher JN and Hoffmeister A designed research; Bucher JN, Strocka S, Gaebelein G, Moche M, Kaiser K, and Bartels M performed research; Strocka S and Moche M contributed analytic tools; Bucher JN and Hollenbach M analyzed data; Bucher JN, Hollenbach M and Hoffmeister A wrote the paper.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: Not applicable, weaver of informed consent due to retrospective study, Ethical Committee consented that no informed consent statement is necessary.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other co-authors contributed their efforts in this manuscript. All the authors have no conflict of interest related to the manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at marcus.hollenbach@web.de.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marcus Hollenbach, MD, Postdoc, Senior Researcher, Senior Scientist, Gastroenterologist, Medical Department II–Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Liebigstraße 20, Leipzig 04103, Saxony, Germany. marcus.hollenbach@web.de
Telephone: +49-341-9712362 Fax: +49-341-9712209
Received: July 31, 2019
Peer-review started: July 31, 2019
First decision: August 27, 2019
Revised: September 25, 2019
Accepted: November 7, 2019
Article in press: November 7, 2019
Published online: November 21, 2019
ARTICLE HIGHLIGHTS
Research background
Transjugular intrahepatic portosystemic shunt (TIPS) is an accepted and emerging intervention in ascites and variceal bleeding related to portal hypertension. Several complications have been described so far but a segmental intrahepatic cholestasis caused by TIPS (SIC-T) was only described as case report so far.
Research motivation
We aimed to perform a retrospective cohort analysis to obtain prevalence and consequences of SIC-T.
Research objectives
Our analysis aimed at prevalence, outcome and risk factors for development of SIC-T.
Research methods
This is a monocentric restrospective cohort analysis. All TIPS patients between January 2005 and August 2013 were screened for signs of biliary congestion. Cases that were conspicuous for SIC-T were reviewed by two independent radiologists. Patients data and procedural details were registered. Logistic regression analysis was performed to identify predictors for the development of SIC-T.
Research results
Out of 135 cirrhotic TIPS patients we identified 4 cases (2.9%) of SIC-T in direct proximity of the TIPS-stent. Main indications for TIPS were refractory ascites and variceal bleeding. Most patients were asymptomatic but one patient suffered from a cholangitic abscess. Logistic regression analysis identified TIPS-placement other than from medial hepatic vein to right portal vein as risk factor (OR 21.0) for SIC-T.
Research conclusions
SIC-T is a relatively rare and late complication of TIPS. Most patient do not require an intervention but severe infectious complications can occur. Patients with multiple interventions or atypical TIPS implantation should be screened for SIC-T.
Research perspectives
Future studies analyzing safety and complications of TIPS should include SIC-T as possible late complication of TIPS.
