• Cirrhosis
• Hepatic encephalopathy
• TIPS

• Humans
• Hepatic Encephalopathy/etiology
• Hepatic Encephalopathy/epidemiology
• Portasystemic Shunt, Transjugular Intrahepatic
• Liver Cirrhosis/complications

• Humans
• Portasystemic Shunt, Transjugular Intrahepatic/adverse effects
• Hepatic Encephalopathy/etiology
• Female
• Male
• Liver Cirrhosis/complications
• Risk Factors
• Middle Aged
• Retrospective Studies
• Ascites/etiology
• Aged
• Age Factors
• Adult
• Diabetes Mellitus/epidemiology
• Logistic Models
• Kaplan-Meier Estimate
• Diabetes Complications
• ROC Curve
• Treatment Outcome
• Postoperative Complications/etiology

• ascites
• brain dysfunction
• cognition
• liver cirrhosis
• portal hypertension
• time trend
• variceal bleeding

• Encephalopathy
• Predictors
• Risk
• TIPS
• Viatorr

• Disease classification
• Hepatic encephalopathy
• Incidence
• Prevalence
• Prevention
• Risk factors

Transjugular intrahepatic portosystemic shunt (TIPS) is effective at treating ascites and variceal bleeding but may be associated with increased morbidity and mortality in older patients. Our aim was to report outcomes in patients 70 years and older who underwent TIPS because data are limited in this population. We performed a retrospective review of patients who underwent TIPS at our institution over 10 years. We matched those 70 years and older to those 50–59 years old by year of TIPS and the Model for End-Stage Liver Diseae-Sodium (MELD-Na). Thirty-day readmissions were higher in the elderly group (n = 50) compared to the younger group (n = 50), n = 17 (34%) and n = 6 (12%) (p = 0.02), respectively. Readmissions for post-TIPS hepatic encephalopathy (HE) in the older and younger groups were n = 14 (28%) and n = 5 (10%) (p = 0.04), respectively. Thirty-day mortality was higher in the older group compared to the younger group, but the difference was not statistically significant, 24% and 12%, respectively (p = 0.19). TIPS can be performed safely in patients 70 years and older, but the overall readmissions, and specifically for HE, were significantly higher in older patients. Patients 70 years and older should be followed closely after TIPS, and early introduction of treatment for encephalopathy should be considered.

• ascites
• encephalopathy
• liver
• stent
• varices

Sarcopaenia, or muscle wasting, can be used to objectively quantify malnutrition in cirrhotic patients.

In this retrospective study, a list of all patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) procedure at Westchester Medical Centre from September 2009 to July 2018 was obtained, and individual chart reviews were performed.

In total, 90 charts were reviewed. Fifty-six patients satisfied our inclusion criteria. Using PMA cut-off values determined in prior studies, we found that 50 of the 56 patients in our study were sarcopaenic. The majority of the patients were male (n = 45). The most common aetiology of cirrhosis was alcoholic cirrhosis (n = 27), followed by viral hepatitis (n = 10), and the most common indication for TIPS was refractory ascites (n = 34). The mean age in the sarcopaenic group was 60.1 years compared to 57.4 years in the non-sarcopaenic group. Mean MELD-Na scores and albumin levels were comparable in both groups. Only one patient was deceased at 6 months post-TIPS. Of the 56 patients included, 18 developed clinically significant hepatic encephalopathy within 6 months of their TIPS procedure. All 18 patients belonged to the sarcopaenic group; 6 patients were not sarcopaenic, and none of them were noted to develop HE within 6 months of their TIPS (p = 0.074)

Based on our results, we concluded that sarcopaenia correlates with the development of hepatic encephalopathy within 6 months of a TIPS procedure; however, the results did not reach statistical significance.

• cirrhosis
• sarcopaenia
• transjugular intrahepatic portosystemic shunt

• HE, hepatic encephalopathy
• HVPG, hepatic venous pressure gradient
• HVWP, hepatic venous wedge pressure
• PTFE, polytetrafluoroethylene
• PVT, portal vein thrombus
• TIPS
• TIPS, transjugular intrahepatic portosystemic shunt
• hepatic encephalopathy
• transjugular intrahepatic portosystemic shunt

• Balloon occlusion
• Gastric varices
• Portal hypertension
• Portosystemic shunt

Background. Transjugular intrahepatic portosystemic shunt (TIPS) is an artificial channel from the portal vein to the hepatic vein or vena cava for controlling portal vein hypertension. The major drawbacks of TIPS are shunt stenosis and hepatic encephalopathy (HE); previous studies showed that post-TIPS shunt stenosis and HE might be correlated with the pathological features of the liver tissues. Therefore, we analyzed the pathological predictors for clinical outcome, to determine the risk factors for shunt stenosis and HE after TIPS. Methods. We recruited 361 patients who suffered from portal hypertension symptoms and were treated with TIPS from January 2009 to December 2012. Results. Multivariate logistic regression analysis showed that the risk of shunt stenosis was increased with more severe inflammation in the liver tissue (OR, 2.864; 95% CI: 1.466–5.592; P = 0.002), HE comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P < 0.001), or higher MELD score (95% CI, 1.298–1.731; P < 0.001). Higher risk of HE was associated with shunt stenosis comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P < 0.001), higher stage of the liver fibrosis (OR, 2.431; 95% CI, 1.355–4.359; P = 0.003), and higher MELD score (95% CI, 1.711–2.406; P < 0.001). Conclusion. The pathological features can predict individual susceptibility to shunt stenosis and HE.

• encephalopathy
• portosystemic shunt
• stent-grafts
• transhepatic
• transjugular

AIM: To evaluate the feasibility of splenectomy with pericardial de-vascularization in patients with intra-hepatic portal hypertension and severe thrombocytopenia.

METHODS: We retrospectively analyzed the clinical data of patients who had undergone splenectomy with pericardial de-vascularization from September 2009 to September 2014 at the Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital of Zhengzhou University. According to the severity of thrombocytopenia, patients were divided into three groups: severe, moderate and mild groups.

RESULTS: A total of 184 patients were included in the analysis; the baseline characteristics of the three groups were matched (P > 0.05). For the severe group, it took 10 days for platelet return to normal range after surgery, and the time was longer than that for the moderate and mild groups. The average drainage volume within 3 days after surgery, intraoperatve blood loss and length of hospital stay in the severe group were 950 mL ± 279 mL, 46.6 g ± 7.4 g and 16.0 d ± 3.5 d, respectively; these values were significantly higher than those in the other two groups (P < 0.01). The bleeding rate and the rates of grade Ⅰ/Ⅱ and grade Ⅲ/Ⅳ portal vein thrombosis in the severe group were 11.62%, 23.26% and 4.65%, respectively, and these value were significantly higher than those in the other two groups (P > 0.05). The cumulative survival rates at 1 year, 3 years, and 5 years were 95.3%, 88.4% and 76.7%, respectively, and there were no significant differences in the three groups (P > 0.05).

CONCLUSION: Through aggressive perioperative management, splenectomy and pericardial de-vascularization may be feasible in patients with portal hypertension and severe thrombocytopenia.

• Portal hypertension
• Severe thrombocytopenia
• Splenectomy with pericardial de-vascularization

• hepatic encephalopathy
• portal hypertension
• spontaneous portosystemic shunt
• transjugular intrahepatic portosystemic shunt

• Aged
• Female
• Humans
• Liver Diseases/complications
• Male
• Middle Aged
• Nervous System Diseases/etiology

AIM: To determine the clinical value of a splenorenal shunt plus pericardial devascularization (PCVD) in portal hypertension (PHT) patients with variceal bleeding.

METHODS: From January 2008 to November 2012, 290 patients with cirrhotic portal hypertension were treated surgically in our department for the prevention of gastroesophageal variceal bleeding: 207 patients received a routine PCVD procedure (PCVD group), and 83 patients received a PCVD plus a splenorenal shunt procedure (combined group). Changes in hemodynamic parameters, rebleeding, encephalopathy, portal vein thrombosis, and mortality were analyzed.

RESULTS: The free portal pressure decreased to 21.43 ± 4.35 mmHg in the combined group compared with 24.61 ± 5.42 mmHg in the PCVD group (P < 0.05). The changes in hemodynamic parameters were more significant in the combined group (P < 0.05). The long-term rebleeding rate was 7.22% in the combined group, which was lower than that in the PCVD group (14.93%), (P < 0.05).

CONCLUSION: Devascularization plus splenorenal shunt is an effective and safe strategy to control esophagogastric variceal bleeding in PHT. It should be recommended as a first-line treatment for preventing bleeding in PHT patients when surgical interventions are considered.

• Comparative study
• Portal hypertension
• Splenorenal shunt
• Devascularization
• Esophagogastric variceal bleeding

• Adolescent
• Adult
• Aged
• Esophageal and Gastric Varices/diagnosis
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/mortality
• Esophageal and Gastric Varices/physiopathology
• Esophageal and Gastric Varices/surgery
• Female
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/mortality
• Gastrointestinal Hemorrhage/physiopathology
• Gastrointestinal Hemorrhage/surgery
• Hemostasis, Surgical/adverse effects
• Hemostasis, Surgical/methods
• Hemostasis, Surgical/mortality
• Humans
• Hypertension, Portal/diagnosis
• Hypertension, Portal/etiology
• Hypertension, Portal/mortality
• Hypertension, Portal/physiopathology
• Liver Cirrhosis/complications
• Male
• Middle Aged
• Operative Time
• Portal Pressure
• Postoperative Complications/etiology
• Retrospective Studies
• Time Factors
• Treatment Outcome
• Young Adult