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Media type:
E-Article
Title:
Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges
Contributor:
Schindler, Philipp;
Heinzow, Hauke;
Trebicka, Jonel;
Wildgruber, Moritz
Published:
MDPI AG, 2020
Published in:
Journal of Clinical Medicine, 9 (2020) 11, Seite 3784
Language:
English
DOI:
10.3390/jcm9113784
ISSN:
2077-0383
Origination:
Footnote:
Description:
Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment tool in decompensated liver cirrhosis that has been shown to prolong transplant-free survival. Hepatic encephalopathy (HE) is a frequent complication of decompensated cirrhosis, eventually induced and/or aggravated by TIPS, that remains a clinical challenge especially in these patients. Therefore, patient selection for TIPS requires careful assessment of risk factors for HE. TIPS procedural parameters regarding stent size and invasive portosystemic pressure gradient measurements thereby have an important role. Endovascular shunt modification, in combination with a conservative medical approach, often results in a significant reduction of symptoms. This review summarizes HE molecular mechanisms and pathophysiology as well as diagnostic and therapeutic approaches targeting shunt-induced HE.