Embolización de colaterales portosistémicas espontáneas como tratamiento de la encefalopatía hepática refractaria

• Autores: Carlos Benítez, Ana Muñoz, Jaime Poniachik, Felipe Ramírez, Claudia Muñoz, Tomás Cermenati, Nicolás Martínez, Pía Díaz, Luis Meneses
• Localización: Revista Médica de Chile, ISSN-e 0034-9887, Vol. 150, Nº. 7, 2022, págs. 879-888
• Idioma: español
• Títulos paralelos:
  • Embolization of spontaneous portosystemic shunts as treatment for refractory hepatic encephalopathy
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• Resumen

  • Background: Hepatic encephalopathy (HE) is a common complication of cirrhosis associated with a reduced survival. The presence of high-flux spontaneous porto-systemic shunts can induce HE even in patients with preserved liver function. Aim: To evaluate the effect of spontaneous porto-systemic shunt embolization (SPSE) over HE and its long-term evolution. Material and Methods: Retrospective analysis of 11 patients (91% males) with severe HE non-responsive to medical treatment in whom a SPSE was performed. The grade of HE (employing West Haven score), survival, MELD and Child-Pugh score, ammonia levels, degree of disability (employing the modified Rankin scale (mRs)) were evaluated before and at thirty days after procedure. Results: The most common etiology found was non-alcoholic steatohepatitis (63.6%). A reduction of at least two score points of HE was observed in all patients after thirty days. There was a significant reduction on median (IQR) West Haven score from 3 (2-3) at baseline to 1 (0-1) after the procedure (p < 0.01). Twelve months survival was 63.6%. There was a decrease in median ammonia level from 106.5 (79-165) (ug/dL) to 56 (43-61) after SPSE (p = 0.006). The median mRS score before and after the procedure was 3 (3-5) and 1 (1-2.5), respectively (p < 0.01). Conclusions: According to our experience, SPSE is a feasible and effective alternative to improve HE and functionality of patients with refractory EH.