Comparison of the impact of shunting the left versus right portal vein branch during TIPS on the postoperative overt hepatic encephalopathy: a randomized trial.

Abstract

Background and aim: The effect of shunting the left or right branch of the portal vein on the post-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) remains controversial. Therefore, we designed this prospective, randomized, single-blinded trial to compare the incidence of HE after shunting the left or right branch of the portal vein during TIPS in cirrhotic patients to prevent variceal rebleeding.

Methods: Consecutive patients diagnosed with hepatitis B virus (HBV)-related cirrhosis were randomly assigned in a 1:1 ratio to undergo the TIPS procedure, with the shunt directed to either the left or right branch of the portal vein. The primary outcome was the incidence of overt HE within 2 years. The secondary outcomes included shunt dysfunction, variceal rebleeding, survival, adverse events, and changes in liver function.

Results: Between June 2019 and December 2020, 130 patients were randomly divided into two groups (left branch group vs right branch group). The 2-year cumulative incidence rates of free overt HE in the left branch group did not demonstrate statistical superiority over the right branch group (78.5% vs 68.6%, respectively; p = 0.236, HR = 1.49, 95% CI 0.76-2.93). Similarly, no statistical differences were observed in stent patency, all-cause bleeding, survival, or adverse events.

Conclusion: Compared to shunting the right branch of the portal vein, shunting the left branch during TIPS placement did not impact the incidence of post-TIPS HE and other clinical outcomes in cirrhotic patients to prevent variceal rebleeding. The choice of puncture site should be primarily guided by the patient's liver anatomy and the operator's experience.