pTIPS Improves Survival in Patients With Hepatic Encephalopathy at Admission

Liver Cirrhosis
Liver with cirrhosis, computer illustration. Cirrhosis is a consequence of chronic liver disease characterized by fibrosis and scarring of tissue.
Researchers examined the outcome of patients with hepatic encephalopathy at admission undergoing pre-emptive transjugular intrahepatic portosystemic shunt.
Hepatic encephalopathy at admission, researchers say, should not be considered a contraindication to pre-emptive TIPS.

Pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) improves survival in patients with cirrhosis and acute variceal bleeding who present with hepatic encephalopathy (HE) at admission, according to study findings published in Gut.

Real-world evidence indicates that less than 15% of eligible patients receive pTIPS because of concerns that the procedure is contraindicated due to the presence of HE at admission.

Researchers conducted an observational study throughout 34 centers from October 2011 to May 2015, analyzing 2138 patients with cirrhosis and acute variceal bleeding. Of the total study population, 671 patients were considered at high risk for mortality. Of the 671 patients, 256 presented with HE.

Clinicians diagnosed HE more frequently in patients at high risk with cirrhosis and acute variceal bleeding than patients at low risk on admission (39.2% vs. 10.6%; P <.001). HE also occurred more frequently in patients at high risk (35 of 66) who received pTIPS than those (221 of 605) who underwent endoscopy and drug treatment (53.0% vs 36.5%; P =.009). Those who received pTIPS demonstrated decreased 1-year mortality risk compared with those who received endoscopy and drug treatment (hazard ratio [HR], 0.374; 95% CI, 0.166-0.845; P =.0181).

The researchers observed no significant difference between HE incidence in the 2 treatment groups, either at admission (pTIPS, 56.4% vs endoscopic treatment, 58.7%; P =.4594) or after treatment (pTIPS, 38.2% vs endoscopic treatment, 38.7%; P=.9721)

“In high-risk patients with HE at admission, pTIPS placement improved survival without increasing the risk of HE, as compared with standard treatment,” the study authors wrote. “Hence, we believe that pTIPS must be considered in high-risk patients with AVB [acute variceal bleeding] and HE at admission.”

Study limitations include small sample sizes, possible differences in modalities used for HE diagnosis, and an inability to distinguish between patients experiencing their first episode of HE or a recurrent episode.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References

Rudler M, Hernández-Gea V, Procopet BD, et al. Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding. Gut. Published online September 9, 2022. doi:10.1136/gutjnl-2022-326975.

This article originally appeared on Gastroenterology Advisor

References:

Rudler M, Hernández-Gea V, Procopet BD, et al. Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding. Gut. Published online September 9, 2022. doi:10.1136/gutjnl-2022-326975.