Embolization of spontaneous portosystemic shunts for refractory hepatic encephalopathy in cirrhosis patients:A meta-analysis.

Abstract

Background and aim: Hepatic encephalopathy is an important cause of morbidity in cirrhosis patients. The presence of spontaneous portosystemic shunts (SPSS) is associated with an increased risk of recurrent/refractory hepatic encephalopathy (HE). Embolization of SPSS has been shown to improve HE symptoms, but it may worsen portal hypertension and related complications. The aim of this study was to determine the efficacy of SPSS embolization for recurrent/refractory HE.

Materials and methods: Five databases were screened to identify studies assessing the efficacy of SPSS embolization for HE. The random-effects model was used to calculate the pooled rates, and I2% values were used to assess heterogeneity.

Results: Twenty-one studies met the inclusion criteria, comprising a total of 331 patients with recurrent or refractory HE despite medical management. The etiology of cirrhosis included ethanol abuse, chronic viral hepatitis, MASH, and others. Following embolization, 82% of patients had HE-related clinical improvement, and 71% of patients became free from HE-related hospitalization. The mean difference in pre- and post-embolization serum ammonia levels was 104 [77-130], p<0.01. Worsening portal hypertension following embolization presented as gastrointestinal bleeding (10%), new or aggravated varices (15%), and new or aggravated ascites (15%).

Conclusion: SPSS embolization demonstrated improvement in HE-related clinical symptoms with a decreased need for hospitalization, but it exacerbates portal hypertension, increasing the risks of ascites, varices, and gastrointestinal bleeding. Future randomized controlled trials are needed to evaluate the efficacy of SPSS embolization against standard medical management.