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Hepatic Encephalopathy in Patients with Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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Hepatic Encephalopathy

Part of the book series: Clinical Gastroenterology ((CG))

Abstract

The following presentation discusses the present knowledge on transjugular intrahepatic portosystemic shunt (TIPS)-induced HE with respect to quality of assessment, incidence, prediction, prevention, and treatment. Unfortunately, most studies used questionable methods and investigators were unblinded necessitating critical interpretation of the data. In numerous longitudinal cohort studies, a major bias may be generated by the fact that pre-TIPS HE has been assessed retrospectively by the patient’s recent history and compared with the prospective evaluation after TIPS. With respect to randomized trials, investigators were unblinded which may have influenced the result disfavouring the TIPS groups. With this in mind, the data published may rather be used as a qualitative orientation confirming a negative effect of the TIPS on HE, but they may not allow to accurately quantify its risk.

Many predictors of post-TIPS HE have been published. Increased age, elevated bilirubin, a low sodium concentration, decreased mean arterial pressure (<87 mmHg), elevated MELD score (above 15), and a critical flicker frequency (<37 Hz) may be of major relevance. In patients with a risk of HE this may be prevented by the use of smaller shunts with a lower reduction of the pressure gradient. If HE occurs, medical treatment is effective in most patients and shunt reduction is an option for those with debilitating chronic HE.

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Authors and Affiliations

  1. Department of Gastroenterology and Radiology, University Hospital Freiburg, Hugstetter Strasse 55, Freiburg, 79106, Germany

    Martin Rössle MD

  2. Department of Radiology, University Hospital Freiburg, Hugstetter Strasse 55, Freiburg, 79106, Germany

    Wulf Euringer MD

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  1. Martin Rössle MD
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  2. Wulf Euringer MD
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Correspondence to Martin Rössle MD .

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  1. , Division of Gastroenterology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, 44145, USA

    Kevin D. Mullen

  2. , Division of Gastroenterology, MetroHealth Medical Center, 2500 MetroHealth Medical Center, Cleveland, 44145, USA

    Ravi K. Prakash

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Rössle, M., Euringer, W. (2012). Hepatic Encephalopathy in Patients with Transjugular Intrahepatic Portosystemic Shunt (TIPS). In: Mullen, K., Prakash, R. (eds) Hepatic Encephalopathy. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-836-8_17

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  • DOI: https://doi.org/10.1007/978-1-61779-836-8_17

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