Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2023; 29(15): 2336-2348
Published online Apr 21, 2023. doi: 10.3748/wjg.v29.i15.2336
Reduction of portosystemic gradient during transjugular intrahepatic portosystemic shunt achieves good outcome and reduces complications
Shi-Hua Luo, Mi-Mi Zhou, Ming-Jin Cai, Shao-Lei Han, Xue-Qiang Zhang, Jian-Guo Chu
Shi-Hua Luo, Mi-Mi Zhou, Ming-Jin Cai, Department of Interventional Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
Shao-Lei Han, Department of Liver Disease, Jinan Infectious Disease Hospital, Shandong University School of Medicine, Jinan 250021, Shandong Province, China
Xue-Qiang Zhang, Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Jian-Guo Chu, Department of Gastroenterology, Air Force Medical Center of PLA, Beijing 100142, China
Author contributions: Chu JG designed the research; Luo SH and Zhou MM performed the research; Han SL, Zhang XQ analyzed the data; Luo SH wrote the paper; Cai MJ revised the paper; All authors have read and approved the final version to be submitted.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Air Force Medical Center of PLA, No. AB-22.12/06.
Informed consent statement: This is a retrospective study, and informed written consent was thus waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Guo Chu, MD, Professor, Department of Gastroenterology, Air Force Medical Center of PLA, No. 30 Fucheng Road, Haidian District, Beijing 100142, China. cjgchina@126.com
Received: December 9, 2022
Peer-review started: December 9, 2022
First decision: January 3, 2023
Revised: January 15, 2023
Accepted: March 23, 2023
Article in press: March 23, 2023
Published online: April 21, 2023
ARTICLE HIGHLIGHTS
Research background

Transjugular intrahepatic portosystemic shunt (TIPS) is placed important role in the therapy of complications of liver cirrhosis. Measuring portosystemic pressure gradient (PSG) is important during the TIPS procedure. Reducing PSG can achieve good clinical results, but when PSG is too low, TIPS leads to many complications. Factors associated with post-TIPS complications depend mainly on portocaval pressure gradient and the volume of blood shunted through the liver. Several guidelines recommend that PSG reduced to 12 mmHg after TIPS creation achieves better clinical outcomes. However, in that situation, the incidence of hepatic encephalopathy (HE) was higher in clinical practice. There is still no suitable criterion for a reduction in PSG, which can both reduce PSG and maximize clinical results and minimize HE, and few data are available to calculate an appropriate PSG value.

Research motivation

We report our multicenter retrospective study to compare the rate of HE and clinical results of reducing PSG by one third of baseline with PSG reduction to < 12 mmHg in patients with portal hypertension who required TIPS placement wtih of variceal bleeding and ascites.

Research objectives

The main objective was to establish that patients who underwent TIPS PSG reduced by one third of baseline compared with PSG reduced to < 12 mmHg of baseline were associated with similar successful clinical outcomes.

Research methods

We hypothesized that reducing PSG by one third of baseline compared with < 12 mmHg of baseline would result in a lower rate of HE and liver compromise. The patients were divided into four groups: Group A (variceal hemorrhage and PSG reduced by one third, n = 479); group B (variceal hemorrhage and PSG reduced to < 12 mmHg, n = 412); group C (refractory ascites and PSG reduced by one third, n = 217); and group D (refractory ascites and PSG reduced to < 12 mmHg, plus medication, n = 172). The clinical outcomes were compared and evaluated. Data measurements results of the four groups were normally distributed, and expressed as mean ± standard deviation, and their differences were determined using t-test. The statistical analyses were performed with SPSS version 22.0.

Research results

This study showed that during TIPS placement, when PSG was reduced by one third compared with < 12 mmHg of baseline, recurrent bleeding showed no significant difference, but recurrent ascites did differ significantly. The probability of total hepatic impairment within 3 years was significantly different. During follow-up, the total incidence of HE differed significantly. The total survival rates were no different for the variceal bleeding patients but were significantly different for the patients with refractory ascites.

Research conclusions

We found that patients who underwent TIPS PSG reduced by one third of baseline compared with reduced to < 12 mmHg of baseline were associated with similar successful clinical outcomes, but PSG reduced by one third resulted in a lower rate of HE and liver compromise.

Research perspectives

Measuring PSG is important during the TIPS procedure. Reducing PSG can achieve good clinical results, but when PSG is too low, TIPS leads to many complications. Reduction of PSG by one third of baseline is recommended to decrease the probability of liver function impairment after TIPS, decrease the incidence of HE, and increase survival in patients with refractory ascites.