Transjugular Intrahepatic Portosystemic Shunt Revision for Hepatic Encephalopathy: A Systematic Review and Meta-Analysis

Tuesday, March 7, 2023

3:54 PM – 4:03 PM

Location: Phoenix Convention Center, 226ABC

Presenting Author(s)

CP

Carlos Pareja, BA (he/him/his)

Medical Student
New Jersey Medical School - -

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

LY

Laura Yuan, BS

Medical Student
Rutgers New Jersey Medical School
RM

Raj Malhotra, BA

Medical Student
Rutgers New Jersey Medical School
Priya Gupta, MBS (she/her/hers)

Medical Student
Rutgers New Jersey Medical School
NN

Neel Nirgudkar, MD

Medical Resident
Rutgers New Jersey Medical School
PS

Pratik A. Shukla, MD

Interventional Radiologist
Rutgers New Jersey Medical School
Abhishek Kumar, MD

Chief, Vascular and Interventional Radiology
Rutgers New Jersey Medical School

Disclosure(s):

Carlos Pareja, BA: No financial relationships to disclose

Priya Gupta, MBS: No financial relationships to disclose

Pratik A. Shukla, MD: No relevant disclosure to display

Abhishek Kumar, MD: Boston Scientific: Consultant (Ongoing), Speaking and Teaching (Ongoing); NAKI Therapeuatics: Advisory Committee or Review Panel Member (Ongoing)

Purpose:

To evaluate methods and outcomes for the revision of transjugular intrahepatic portosystemic shunts (TIPS) following the development of refractory hepatic encephalopathy (RHE).

Materials and Methods:

PubMed and ScienceDirect databases were searched from 2007 – 2022 for articles describing shunt reduction techniques for post-TIPS RHE. Inclusion criteria were as follows: studies reporting ≥5 patients, technique, and RHE post-reduction. Demographics, clinical data, procedural details, outcomes, and complications were recorded. A meta-analysis of TIPS reduction outcomes was completed.

Results:

9 studies met inclusion criteria, and 102 patients (mean age 61 years) underwent TIPS reduction for RHE by the parallel stent technique (n = 41) and the hourglass technique (n = 63) with a 100% technical success rate. 2 patients who initially underwent hourglass TIPS reduction required revision with parallel stent {1,2}. PPG increased by 6.1 ± 1.4 mmHg for parallel and 7.1 ± 2.3 mmHg for hourglass. 81% of parallel revisions had shunt diameters >5 mm and 82% of hourglass revisions were ≤5 mm. 26% of parallel and 29% of hourglass procedures had complications (i.e., ascites, occlusion, and variceal bleeding). 79% of parallel stent patients and 76% of hourglass patients demonstrated improved RHE post-revision.

Conclusion:

The TIPS reduction procedures described are safe and effective and improve clinical outcomes as demonstrated by RHE improvement. Additional studies should be completed in a larger cohort for validation of these findings.