Evaluation of mid- and long-term efficacy of shunt limiting for hepatic myelopathy after transjugular intrahepatic portosystemic shunt.
Clin Res Hepatol Gastroenterol 2016;
40:440-6. [PMID:
26724169 DOI:
10.1016/j.clinre.2015.11.004]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 11/16/2015] [Accepted: 11/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND
Hepatic myelopathy (HM) is a rare condition caused by severe liver dysfunction, and may be secondary to transjugular intrahepatic portosystemic shunt (TIPS). This study aimed to evaluate the mid- and long-term clinical efficacy of TIPS reduction (TIPSR) for treatment of HM secondary to TIPS.
METHODS
Patients who underwent TIPS (n=1325) for severe portal hypertension between August 2002 and August 2013 at the Affiliated Beijing Millennium Monument Hospital, Capital Medical University (Beijing, China) were reviewed. During follow-up, 22 patients were diagnosed with HM, and 12 underwent TIPSR. Patients were evaluated using the Barthel index (daily activities), the Lovette's Six Classification (lower extremity muscle strength), and the Fugl-Meyer assessment (FMA; lower extremity activity). Hepatic encephalopathy grade was used to assess the severity of clinical symptoms.
RESULTS
TIPSR did not affect portal vein pressure (31.6±6.2 vs. 33.3±7.9mmHg, P=0.55). Blood ammonia levels were 77.9±17.9mmol/L before TIPSR and 77.9±14.8, 73.5±21.5, 59.5±14.5, and 52.0±16.5mmol/L at 1, 3, 6, and 12months (P<0.05 for 6 and 12months vs. baseline). The Barthel index was improved 6months after TIPSR (42.1±10.5 vs. 45.0±8.8, P<0.05), while FMA was improved 3months after TIPSR only (24.6±3.2 vs. 25.5±3.2, P<0.05). Lovette's Six Classification was improved 12months after TIPSR (2.1±0.7 vs. 2.8±0.9, P<0.05). After TIPS, hepatic encephalopathy grade was I (n=3), II (n=6), III (n=2), or IV (n=1), and was I (n=8), II (n=1), or III (n=1) at 6months.
CONCLUSION
TIPSR can improve the mid- and long-term symptoms of HM secondary to TIPS.
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