Shunt embolization and balloon-occluded retrograde transvenous obliteration procedures to treat hepatic encephalopathy

Abstract

Introduction: Hepatic encephalopathy (HE) develops in up to 50% of patients with decompensated cirrhosis. Balloon-occluded retrograde transvenous obliteration (BRTO) has been shown to be effective in controlling gastric variceal bleeding.Materials and Methods: This is a descriptive and hospital based study conducted at Department of Interventional Radiology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore. Seven cases of BRTO were identified from January 2020 to December 2020. Patients refractory to medical treatment having treatable porto-systemic shunts were included. Most had gastro-renal shunts. Jugular or femoral approach or both approaches were used to do the procedure. Results: Out of total 7 cases, in 4 cases we used Amplatzer Vascular Plugs (AVP II) combined with coils and in 3 cases sclerosing agents along with coils. All patients were followed for 3, 6, 9 and 12 months. Five patients showed encephalopathy free duration of more than 6 months. Three patients undergone liver transplantation over period of 2years. Post BRTO there were no renal vein thrombosis noted.Conclusion: BRTO and shunt embolization show good short-term results in reducing hepatic encephaolopathy episodes in patient’s refractory to medical treatment.