Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges
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 T...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/11/3784 |
| _version_ | 1797547102205640704 |
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| author | Philipp Schindler Hauke Heinzow Jonel Trebicka Moritz Wildgruber |
| author_facet | Philipp Schindler Hauke Heinzow Jonel Trebicka Moritz Wildgruber |
| author_sort | Philipp Schindler |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T14:38:26Z |
| format | Article |
| id | doaj.art-eefc6cae5eb543cebc54fdbbcc494659 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T14:38:26Z |
| publishDate | 2020-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-eefc6cae5eb543cebc54fdbbcc4946592023-11-20T22:01:19ZengMDPI AGJournal of Clinical Medicine2077-03832020-11-01911378410.3390/jcm9113784Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical ChallengesPhilipp Schindler0Hauke Heinzow1Jonel Trebicka2Moritz Wildgruber3Institute of Clinical Radiology, University Hospital Muenster, D-48149 Muenster, GermanyDepartment of Gastroenterology and Hepatology, University Hospital Muenster, D-48149 Muenster, GermanySection Translational Hepatology, Department for Internal Medicine I, Goethe University Frankfurt, D-60596 Frankfurt, GermanyInstitute of Clinical Radiology, University Hospital Muenster, D-48149 Muenster, GermanyTransjugular 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.https://www.mdpi.com/2077-0383/9/11/3784hepatic encephalopathytransjugular portosystemic intrahepatic shuntliver cirrhosis |
| spellingShingle | Philipp Schindler Hauke Heinzow Jonel Trebicka Moritz Wildgruber Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges Journal of Clinical Medicine hepatic encephalopathy transjugular portosystemic intrahepatic shunt liver cirrhosis |
| title | Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges |
| title_full | Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges |
| title_fullStr | Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges |
| title_full_unstemmed | Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges |
| title_short | Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges |
| title_sort | shunt induced hepatic encephalopathy in tips current approaches and clinical challenges |
| topic | hepatic encephalopathy transjugular portosystemic intrahepatic shunt liver cirrhosis |
| url | https://www.mdpi.com/2077-0383/9/11/3784 |
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