Transjugular retrograde obliteration for chronic portosystemic encephalopathy

Chronic portosystemic encephalopathy (CPSE) is uncommon, and its management has yet to be determined. We have been able to control five cases of CPSE using transjugular retrograde obliteration (TJO), and we report our clinica l results with this technique. All of the five patients were suffering from cirrhosis and had gastric varices and large gastrorenal shunts. According to Sherlock's classification, the grade of encephalopathy was II in two pat ients, III in two, and IV in one. According to Child's classification, one had class B and four had class C cirrhosis. TJO was performed using a 6-F a ngiographic catheter with an occlusive balloon 20 mm in diameter. Absolute ethanol and 5% ethanolamine oleate with iopamidol were used to obliterate t he gastrorenal shunt. The gastrorenal shunt was successfully obliterated, a nd the encephalopathy improved to grade 0 after TJO in all cases. The porta l flow volume increased significantly from 542 +/- 189 to 992 +/- 139 mL/mi n (p < 0.01). The plasma ammonia levels before and after TJO were 189 +/- 4 0 and 51 +/- 23 <mu>g/dL, and the indocyanine green retention rates at 15 m in were 44 +/- 13% and 27 +/- 12%, with both changes being significant (p ( 0.01), Minor complications observed were fever of over 38 degreesC and tar ry stools due to hemorrhagic gastritis in one patient, which was being cont rolled conservatively. One patient died of hepatocellular carcinoma 27 mont hs after TJO. The other four patients survived without recurrence of CPSE 1 7-74 months (44 +/- 24 months) after TJO. We conclude that TJO can be adopt ed as a safe and effective treatment for CPSE.