Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2023; 29(15): 2336-2348
Published online Apr 21, 2023. doi: 10.3748/wjg.v29.i15.2336
Reduction of portosystemic gradient during transjugular intrahepatic portosystemic shunt achieves good outcome and reduces complications
Shi-Hua Luo, Mi-Mi Zhou, Ming-Jin Cai, Shao-Lei Han, Xue-Qiang Zhang, Jian-Guo Chu
Shi-Hua Luo, Mi-Mi Zhou, Ming-Jin Cai, Department of Interventional Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
Shao-Lei Han, Department of Liver Disease, Jinan Infectious Disease Hospital, Shandong University School of Medicine, Jinan 250021, Shandong Province, China
Xue-Qiang Zhang, Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Jian-Guo Chu, Department of Gastroenterology, Air Force Medical Center of PLA, Beijing 100142, China
Author contributions: Chu JG designed the research; Luo SH and Zhou MM performed the research; Han SL, Zhang XQ analyzed the data; Luo SH wrote the paper; Cai MJ revised the paper; All authors have read and approved the final version to be submitted.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Air Force Medical Center of PLA, No. AB-22.12/06.
Informed consent statement: This is a retrospective study, and informed written consent was thus waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Guo Chu, MD, Professor, Department of Gastroenterology, Air Force Medical Center of PLA, No. 30 Fucheng Road, Haidian District, Beijing 100142, China. cjgchina@126.com
Received: December 9, 2022
Peer-review started: December 9, 2022
First decision: January 3, 2023
Revised: January 15, 2023
Accepted: March 23, 2023
Article in press: March 23, 2023
Published online: April 21, 2023
Processing time: 126 Days and 11.3 Hours
Abstract
BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) is placed important role in the therapy of complications of portal hypertension, there is still no suitable criterion for a reduction in portosystemic gradient (PSG), which can both reduce PSG and maximize clinical results and minimize hepatic encephalopathy (HE).

AIM

To compare the clinical outcomes and incidence of HE after one-third PSG reduction during TIPS in patients with variceal bleeding and refractory ascites.

METHODS

A total of 1280 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2016 to January 2019 were analyzed retrospectively. Patients were divided into group A (variceal hemorrhage and PSG reduced by one third, n = 479); group B (variceal hemorrhage and PSG reduced to < 12 mmHg, n = 412); group C (refractory ascites and PSG reduced by one third, n = 217); and group D (refractory ascites and PSG reduced to < 12 mmHg of PSG, plus medication, n = 172). The clinical outcomes were analyzed.

RESULTS

By the endpoint of follow-up, recurrent bleeding was no different between groups A and B (χ2 = 7.062, P = 0.374), but recurrent ascites did differ significantly between groups C and D (χ2 = 14.493, P = 0.006). The probability of total hepatic impairment within 3 years was significantly different between groups A and B (χ2 = 11.352, P = 0.005) and groups C and D (χ2 = 13.758, P = 0.002). The total incidence of HE differed significantly between groups A and B (χ2 = 7.932, P = 0.016), groups C and D (χ2 = 13.637, P = 0.007). There were no differences of survival rate between groups A and B (χ2 = 3.376, P = 0.369, log-rank test), but did differ significantly between groups C and D (χ2 = 13.582, P = 0.014, log-rank test).

CONCLUSION

The PSG reduction by one third may reduce the risk of HE, hepatic function damage and achieve good clinical results.

Keywords: Portal hypertension; Transjugular intrahepatic portosystemic shunt; Portosystemic gradient; Liver cirrhosis; Variceal bleeding; Refractory ascites

Core Tip: Patients with cirrhosis who underwent transjugular intrahepatic portosystemic shunt for recurrent variceal bleeding and refractory ascites were evaluated. Reduction in portosystemic gradient (PSG) should be based on the original basal pressure and reduction by one third may reduce the risk of hepatic encephalopathy, hepatic function damage and achieve similar clinical results as for the refractory ascites patients. Appropriate reduction of PSG directly influences the patient prognosis.