Therapeutic effect of balloon-occluded retrograde transvenous obliterationon portal-systemic encephalopathy in patients with liver cirrhosis

Objective Balloon-occluded retrograde transvenous obliteration (B-RTO) has recently been introduced as a new interventional modality to prevent fatal bleeding from solitary gastric varices. A large portal-systemic shunt inclu ding gastric varices also causes severe encephalopathy in some cirrhotic pa tients. In this study, we evaluated the effect of B-RTO as a candidate ther apeutic method to treat chronic recurrent hepatic encephalopathy due mainly to a portal-systemic shunt. Patients and Methods Since July 1995, we experienced 43 cirrhotic patients with chronic reccurent hepatic encephalopathy. Among them, six patients had anigographically proven large (> 1 cm in diameter) portal-systemic shunt, and received B-RTO. B-RTO was carried out only once using 5% ethanolamine o leate with iopamidole to obliterate the portal-systemic shunt for 30 minute s. The median observation period after B-RTO was 29 months (range 23-46 mon ths). Results In all 6 patients, encephalopathy had disappeared after B-RTO, and the patients were free of encephalopathy during the following 6 months. B-R TO significantly reduced blood ammonia levels at one month, 3 months, and 6 months later, without affecting serum aspartate aminotransferase activity, total bilirubin and albumin concentrations, and plasma prothrombin time. E ncephalopathy relapsed in 4 patients between 6 and 30 months. Additional B- RTO was required and effective in 2 of them. Conclusion B-RTO is an effective treatment for chronic recurrent hepatic en cephalopathy with an angiographically proven portal-systemic shunt.