PORTOSYSTEMIC ENCEPHALOPATHY AFTER TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT - RESULTS OF A PROSPECTIVE CONTROLLED-STUDY

Portosystemic encephalopathy is a common complication of surgical port acaval shunts. Recently, transjugular intrahepatic portosystemic shunt s have been proposed to produce portal decompression in a manner analo gous to a side-to-side portacaval shunt, but with less morbidity. The incidence and clinical spectrum of portosystemic encephalopathy after transjugular intrahepatic portosystemic shunts, however, had not been previously prospectively defined. We therefore prospectively studied p ortosystemic encephalopathy in 30 patients undergoing transjugular int rahepatic portosystemic shunts and compared these findings with 25 pat ients concurrently undergoing sclerotherapy (controls). At entry, both study groups were comparable. Portosystemic encephalopathy was assess ed by examining and grading mental status, asterixis, plasma ammonia a nd trail making tests. The portosystemic encephalopathy index was calc ulated from these parameters. Nine of 30 patients with transjugular in trahepatic portosystemic shunts experienced 24 episodes of acute porto systemic encephalopathy during follow-up; 6 of 9 had a history of port osystemic encephalopathy before transjugular intrahepatic portosystemi c shunts and 5 of these 6 patients had Child C cirrhosis. Mental statu s and asterixis scores as well as portosystemic encephalopathy index w orsened significantly in the first month after transjugular intrahepat ic portosystemic shunts but showed some improvement thereafter. Increa sing age, a medical history of portosystemic encephalopathy and trail scores for part B greater than 100 sec were predictors of portosystemi c encephalopathy after transjugular intrahepatic portosystemic shunts. Portosystemic encephalopathy could be managed medically in all but on e patient who underwent liver transplant. In contrast, there were no s ignificant changes in mental status, asterixis, ammonia or trail score s over time in sclerotherapy controls. Only six episodes of encephalop athy occurred in endoscopic sclerotherapy patients over the duration o f the study. Thus, overall risk of portosystemic encephalopathy after transjugular intrahepatic portosystemic shunts was higher than during sclerotherapy.-