Li Y, Wu YT, Wu H. Management of hepatic encephalopathy following transjugular intrahepatic portosystemic shunts: Current strategies and future directions. World J Gastroenterol 2025; 31(15): 103512 [DOI: 10.3748/wjg.v31.i15.103512]
Corresponding Author of This Article
Hao Wu, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu 610041, Sichuan Province, China. 594264513@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
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/
World J Gastroenterol. Apr 21, 2025; 31(15): 103512 Published online Apr 21, 2025. doi: 10.3748/wjg.v31.i15.103512
Management of hepatic encephalopathy following transjugular intrahepatic portosystemic shunts: Current strategies and future directions
Ying Li, Yu-Tong Wu, Hao Wu
Ying Li, Hao Wu, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Yu-Tong Wu, Chongqing Medical University-University of Leicester Joint Institute, Chongqing Medical University, Chongqing 400016, China
Co-first authors: Ying Li and Yu-Tong Wu.
Author contributions: Li Y and Wu YT reviewed literature and produced the initial draft; Wu H reviewed and edited the manuscript. All authors have read and approved the final manuscript. Li Y and Wu YT contributed equally to this work as co-first authors.
Supported by the National Natural Science Foundation of China, No. 82270649.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Hao Wu, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu 610041, Sichuan Province, China. 594264513@qq.com
Received: November 22, 2024 Revised: March 4, 2025 Accepted: April 2, 2025 Published online: April 21, 2025 Processing time: 148 Days and 1.4 Hours
Abstract
Transjugular intrahepatic portosystemic shunts (TIPSs) are generally used for the management of complications of portal hypertension in patients with decompensated cirrhosis. However, hepatic encephalopathy (HE), which impairs neuropsychiatric function and motor control, remains the primary adverse effect of TIPS, limiting its utility. Prompt prevention and treatment of post-TIPS HE are critical, as they are strongly associated with readmission rates and poor quality of life. This review focuses on the main pathophysiological mechanisms underlying post-TIPS HE, explores advanced biomarkers and predictive tools, and discusses current management strategies and future directions to prevent or reverse HE following TIPS. These strategies include preoperative patient assessment, individualized shunt diameter optimization, spontaneous portosystemic shunt embolization during the TIPS procedure, postoperative preventive and therapeutic measures such as nutrition management, medical therapy, fecal microbiota transplantation, and stent reduction.
Core Tip: Hepatic encephalopathy (HE) is the main complication following transjugular intrahepatic portosystemic shunt (TIPS), significantly impairs patients’ quality of life. Preoperative evaluation is crucial to mitigate the risk of post-TIPS HE. The shunt diameter and embolization of spontaneous portosystemic shunts should be considered according to the portal pressure gradient. Rifaximin is effective for preventing post-TIPS HE. Endovascular shunt reduction is a potential intervention for refractory HE post-TIPS. Sarcopenia is associated with post-TIPS HE, and the impact of nutritional management on HE following TIPS warrants further investigation. The efficacy of fecal microbiota transplantation in post-TIPS HE requires further validation.
