Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy

Table 1 Baseline characteristics in the two groups

Characteristics	Group A	Group B	P value
Gender, M/F	398/539	166/141	0.308
Age in yr, mean ± SD	44.48 ± 18.23	40.80 ± 17.76	0.381
Child-Pugh A/B/C	79/729/137	25/160/122	0.753
MELD score, mean ± SD	13.19 ± 7.35	12.26 ± 8.47	0.591
Viral hepatitis	585	194	0.947
Chronic ethanol consumption	210	61	0.651
Autoimmune hepatitis	53	23	0.463
Metabolic liver disease	89	29	0.527
Variceal hemorrhage	653	236	0.163
Refractory ascites	384	117	0.125
Laboratory tests
Alanine transaminase in U/L	69.13 ± 12.21	56.24 ± 11.17	0.615
Aspartate transaminase in U/L	56.14 ± 14.19	49.53 ± 12.24	0.653
Alkaline phosphatase in U/L	129.63 ± 26.32	136.46 ± 27.02	0.534
γ-glutamyl transpeptidase in U/L	236.23 ± 62.46	248.13 ± 53.32	0.561
Total bilirubin in μmol/L	24.32 ± 5.63	26.46 ± 6.37	0.482
Albumin in g/L	29.14 ± 7.22	31.23 ± 6.52	0.237
Prothrombin time in s	16.03 ± 7.31	18.46 ± 5.17	0.316
Clinical presentations
Abdominal distention	627	193	0.164
Abdominal pain	48	17	0.237
Weakness	473	136	0.253
Poor appetite	729	275	0.428
Jaundice	15	6	0.107
Splenomegaly	482	174	0.316
Lower limbs edema	136	57	0.263
Endoscopic therapy	1736	625	0.421
Ascites paracentesis	1492	479	0.304

No difference could be seen in terms of age, sex, Child-Pugh score, Model of End-Stage Liver Disease score, laboratory tests and clinical presentations (P > 0.05). MELD: Model of End-Stage Liver Disease; SD: Standard deviation.

Table 2 Portosystemic gradient changes in the two groups

Groups	PSG in mmHg		t value	P value
	Before	After
Group A	27.08 ± 5.47	10.75 ± 3.67	13.79	0.001
Group B	26.42 ± 3.53	10.96 ± 2.41	18.64	0.003
	(T value) 0.622	0.284
	(P value) 0.536	0.777

Both TIPS procedures demonstrated a similar efficacy in decreasing portosystemic gradient before and after TIPS placement. PSG: Portosystemic gradient; TIPS: transjugular intrahepatic portosystemic shunt.

Table 3 HE occurrence in the two groups

Time	Group	HE occurrence		HE occurrence rate, %	Covert	HE grade			χ2	P value
		Yes	No			II	III	IV
1 mo	A	140	797	14.94	44	78	10	8	4.839	0.028
	B	113	194	36.80	27	56	18	12
3 mo	A	117	820	12.48	34	59	17	7	5.054	0.025
	B	105	202	34.20	26	58	11	10
6 mo	A	94	843	10.03	53	32	6	3	6.560	0.010
	B	99	208	32.24	36	46	9	8
9 mo	A	86	851	9.17	42	31	7	6	5.357	0.021
	B	96	211	31.27	46	37	9	4
12 mo	A	77	860	8.21	34	35	6	3	3.848	0.051
	B	86	221	28.01	28	39	11	8
3 yr	A	62	875	6.61	25	31	6	0	1.204	0.272
	B	22	285	7.16	12	6	4	0
5 yr	A	47	890	5.01	23	24	0	0	0.072	0.562
	B	19	288	6.18	12	5	2	0

There was a significant difference in incidence of hepatic encephalopathy in group A compared with group B at 1, 3, 6, 9 and 12 mo (P < 0.05), whereas at 3 and 5 years, there were no significant differences between the groups (P > 0.05). P = 0.562 by Fisher’s exact test. HE: Hepatic encephalopathy.

Table 4 Outcomes of symptoms in the two groups

Symptoms	Group A	Group B	P value
Absorption of ascites within the first week	357	11	0.364
Recurrence of bleeding	112	49	0.278
Recurrence of ascites	185	64	0.561

The symptom of ascites within the first week without paracentesis did not differ significantly between the groups (P = 0.364). By the endpoint of follow-up, recurrent bleeding and ascites did not differ significantly between the groups (P = 0.278, P = 0.561, respectively).

Table 5 One-, three- and five-year survival rates in the two groups

Time	Group	Survival		Survival rate, %	χ2	P value
		Yes	No
1 yr	A	796	141	84.95	0.326	0.568
	B	245	62	79.80
3 yr	A	726	211	77.48	0.364	0.564
	B	219	88	71.33
5 yr	A	632	305	67.44	0.178	0.673
	B	193	114	62.86

The 1-, 3-, and 5-year survival rates did not differ between groups A and B (χ² = 0.326, P = 0.568; χ² = 0.364, P = 0.564 and χ² = 0.178, P = 0.673, respectively).