Prevention and treatment of hepatic encephalopathy during the perioperative period of transjugular intrahepatic portosystemic shunt

Table 1 Relative contraindications for nonemergency transjugular intrahepatic portosystemic shunt (based on the risk of postoperative-transjugular intrahepatic portosystemic shunt related hepatic encephalopathy)

Relative contraindications for nonemergency transjugular intrahepatic portosystemic shunt
Prior HE episodes
Serious liver dysfunction (Child-Pugh ≥ 12 or MELD ≥ 18)
Advanced age (> 70 yr)
High creatinine (serum creatinine > 1.1 mg/dL)
Cachexia
Cognitive impairment
Lack of social and family support

HE: Hepatic encephalopathy; MELD: Model for End-Stage Liver Disease.

Table 2 Modalities for preventing and treating postoperative transjugular intrahepatic portosystemic shunt-related hepatic encephalopathy

Prevention	Treatment
Lactulose	Lactulose
Rifaximin	Rifaximin
Albumin (potential)	Correction of biochemical parameters
	Withdrawal of nocturnal sedation
	Discontinued use of PPIs
	Stent flow restriction
	Liver transplantation

PPIs: Proton pump inhibitors.