Safety and efficacy of flow-reducing stent in treatment of recurrent or persistent hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Objective To investigate the safety and efficacy of flow-reducing stent in the treatment of recurrent or persistent hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) . Methods A total of 11 patients who were diagnosed with recurrent or persistent HE after TIPS in The First Affiliated Hospital of Air Force Medical University from January 2013 to August 2018 were enrolled. Objective scales were used to evaluate the patients with HE before and after the implantation of flow-reducing stent. Metal covered stents with the same type and an appropriate length were selected as the flow-reducing stents, and conventional portal venography and hepatic venous pressure gradient measurement were performed during and after surgery. The primary endpoint was the change in HE. The paired t-test was used to analyze the changes in related indices after surgery. Results All 11 patients underwent successful implantation of the flow-reducing stent. Within 1 week after implantation, 8 patients had disappearance of HE and 2 had HE reduced to grade 1, among whom 1 had no marked improvement in HE due to severe liver cirrhosis and liver failure. Of all patients, 2 used the 4-mm flow-reducing stent, 8 used the 5-mm flow-reducing stent, and 1 used the 6-mm flow-reducing stent, and there was a significant increase in hepatic venous pressure gradient after surgery [ (6. 09 ± 0. 70) mm Hg vs (15. 36 ± 2. 94) mm Hg, t = 2. 53, P = 0. 003 8]. There was a significant reduction in the time for digital coding test after surgery [ (269 ± 80) s vs (464 ± 90) s, t = 2. 94, P = 0. 001]. The patients had a significant improvement in albumin at 1 month after surgery (t = 1. 75, P = 0. 013) . The 2 patients receiving the 4-mm flow-reducing stent died of gastrointestinal bleeding at 6 and 12 months after surgery, respectively; among the 8 patients receiving the 5-mm flow-reducing stent, 2 experienced rebleeding at 3 months after surgery, 1 experienced massive ascites at 15 months after surgery, and 1 died of jaundice, intrac-table ascites, and liver failure at 2 years after surgery; the 1 patient receiving the 6-mm flow-reducing stent died of acute-on-chronic liver failure on day 25 after surgery. Conclusion Flow-reducing stent can effectively improve recurrent or persistent HE after TIPS and is safe and feasible; however, a small diameter of stent may lead to increased portal hypertension due to stent restenosis.