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Comparison of patients with hepatic encephalopathy and those with gastric varices before and after balloon‐occluded retrograde transvenous obliteration
Author(s) -
Ishikawa Tsuyoshi,
Sasaki Ryo,
Nishimura Tatsuro,
Matsuda Takashi,
Maeda Masaki,
Iwamoto Takuya,
Saeki Issei,
Hidaka Isao,
Takami Taro,
Sakaida Isao
Publication year - 2018
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13199
Subject(s) - medicine , portal venous pressure , hepatic encephalopathy , gastric varices , portal hypertension , balloon , splenic vein , transjugular intrahepatic portosystemic shunt , surgery , gastroenterology , cirrhosis
Aim To compare the clinical characteristics of patients with hepatic encephalopathy (HE) and those with gastric varices (GV) before and after balloon‐occluded retrograde transvenous obliteration (BRTO). Methods Eighty cirrhotic patients who underwent BRTO, including 42 men and 38 women, and whose mean age was 68 years, comprised the HE ( n = 18) and GV ( n = 62) groups. The patients’ data before and 1 month after BRTO were analyzed. Results Before BRTO, the groups did not differ in their portal flow volume (PFV) or hepatic venous pressure gradient (HVPG). The portal vein (PV) was narrower and the splenic vein (SpV) was wider in the HE group than in the GV group. The SpV flow was hepatofugal in 75.0% of HE patients and hepatopetal in 92.6% of GV patients. The Child–Pugh (CP) score of the HE group was significantly higher than that of the GV group pre‐BRTO. After BRTO, the PFV and HVPG increases in the HE group equaled those in the GV group, and the PV dilation was similar in both groups. Conversely, the SpV was significantly contracted for HE patients, but significantly dilated for GV patients. Postoperatively, the SpV flow was hepatopetal in all patients. Compared to that in the GV group, the CP score decreased markedly in the HE group, and no significant increases in complications occurred post‐BRTO for HE patients. Conclusions The HE patients showed distinct portal‐splenic hemodynamics before and after BRTO. Balloon‐occluded retrograde transvenous obliteration markedly improved hepatic function in the HE group compared with the GV group.