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. 2019 Dec;42(12):1760-1770.
doi: 10.1007/s00270-019-02295-6. Epub 2019 Jul 30.

Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Schistosomiasis-Induced Liver Fibrosis

Jiacheng Liu  1   2 , Binqian Zhou  3   2 , Dongpin Chen  1   2 , Chen Zhou  1   2 , Qin Shi  1   2 , Chuansheng Zheng  1   2 , Gansheng Feng  1   2 , Feng Yuan  1   2 , Yan Ge  1   2 , Bin Xiong  4   5
Affiliations

Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Schistosomiasis-Induced Liver Fibrosis

Jiacheng Liu et al. Cardiovasc Intervent Radiol. 2019 Dec.

Abstract

Purpose: Evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) insertion on patients with schistosomiasis-induced liver fibrosis, and compare with that of patients with HBV-induced cirrhosis.

Materials and methods: This was a retrospective study from November 2015 to December 2018 including 82 patients diagnosed with portal hypertension, one group of which is induced by schistosomiasis (n = 20), the other by hepatitis B virus (HBV) (n = 62). Both groups of subjects underwent TIPS placement for the management of portal hypertension complications.

Results: TIPS was inserted successfully in all patients (technical success 100%). After a median follow-up of 14 months following TIPS insertion, portal pressure gradient (PPG) value in both schistosomiasis-induced group and HBV-induced group underwent a significant decrease with no major difference between the two groups. There exists no significant difference demonstrated by Kaplan-Meier curves between two groups concerning cumulative rate of hepatic encephalopathy (HE) (log-rank p = 0.681), variceal rebleeding (log-rank p = 0.837) and survival (log-rank p = 0.429), and no statistically difference was found in terms of alleviation of portal vein thrombosis (PVT). In addition, splenectomy (HR 19, 95% CI 4-90, p < 0.001) was identified as independent predictor of PVT.

Conclusions: TIPS placement is well-founded to be considered as a safe and effective treatment in patients with schistosomiasis-induced portal hypertension and relevant severe complications. We also found the risk of PVT is 19 times higher in patients who underwent splenectomy than in untreated patients.

Level of evidence: Historically controlled studies, level 4.

Keywords: Gastroesophageal variceal bleeding; Hepatic encephalopathy; Portal hypertension; Schistosomiasis; Transjugular intrahepatic portosystemic shunt.

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Conflict of interest statement

No potential conflicts of interest were disclosed.

Figures

Fig. 1
Fig. 1
Typical symptoms of schistosomiasis-induced liver fibrosis. A The capsular calcification was found in the CT scan of a 52-year-old man; B widening of ligamentum teres, portal vein thrombosis (PVT) and insufficient liver perfusion in the CT enhanced scan of a 54-year-old woman; C ascites and prominent collateral circulation in the CT enhanced scan of a 70-year-old woman; D portal branches fibrosis in the T2-weighted image of a 31-year-old man
Fig. 2
Fig. 2
The images of TIPS procedure on a 31-year-old male with schistosomiasis-induced portal hypertension. A Portal vein was successfully punctured, and pigtail catheter was placed in SMV, followed by angiography revealing PVT and gastric esophageal varices; B after TIPS insertion, blood perfusion was satisfying in the stent as displayed
Fig. 3
Fig. 3
Kaplan–Meier curves of HE (A), rebleeding (B) and cumulative survival (C) in our study. There were no significant differences in two groups concerning the probability of HE, rebleeding and cumulative survival; the log-rank p values of which were, respectively, 0.681, 0.837 and 0.429
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