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Abstract Details
Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges
J Clin Med. 2020 Nov 23;9(11):3784. doi: 10.3390/jcm9113784.
Philipp Schindler1, Hauke Heinzow2, Jonel Trebicka3, Moritz Wildgruber14
Author information
1Institute of Clinical Radiology, University Hospital Muenster, D-48149 Muenster, Germany.
2Department of Gastroenterology and Hepatology, University Hospital Muenster, D-48149 Muenster, Germany.
3Section Translational Hepatology, Department for Internal Medicine I, Goethe University Frankfurt, D-60596 Frankfurt, Germany.
4Department of Radiology, University Hospital, LMU Munich, D-81377 Munich, Germany.
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment tool in decompensated liver cirrhosis that has been shown to prolong transplant-free survival. Hepatic encephalopathy (HE) is a frequent complication of decompensated cirrhosis, eventually induced and/or aggravated by TIPS, that remains a clinical challenge especially in these patients. Therefore, patient selection for TIPS requires careful assessment of risk factors for HE. TIPS procedural parameters regarding stent size and invasive portosystemic pressure gradient measurements thereby have an important role. Endovascular shunt modification, in combination with a conservative medical approach, often results in a significant reduction of symptoms. This review summarizes HE molecular mechanisms and pathophysiology as well as diagnostic and therapeutic approaches targeting shunt-induced HE.