THE REDUCING STENT - TREATMENT FOR TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT - INDUCED REFRACTORY HEPATIC-ENCEPHALOPATHY AND LIVER-FAILURE

PURPOSE: To examine the efficacy of a stent device in reducing the dia meter of transjugular intrahepatic portosystemic shunts (TIPS) in pati ents with progressive liver failure or with shunt-induced hepatic ence phalopathy. MATERIALS AND METHODS: Seven patients with TIPS (four with severe hepatic encephalopathy, three with progressive liver failure) underwent transjugular implantation of a stent designed to reduce the flow through the original TIPS channel. RESULTS: Implantation of the r educing stent proceeded without complication. Duplex sonography showed that stent Bow decreased by 41% +/- 18 (mean +/- standard deviation). The four patients with hepatic encephalopathy showed substantial impr ovement. Concentrations of plasma ammonium and serum bilirubin improve d considerably. In contrast, functional impairment progressed in the t hree patients treated for liver failure. The patients soon died. CONCL USION: With the limited experience of treating these seven patients, t he authors suggest that shunt-induced hepatic encephalopathy can be ef fectively treated with implantation of a reducing stent. Hepatic failu re, however, is a deleterious complication that seems to be irreversib le.