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. 2025 Oct 27;17(10):110849.
doi: 10.4254/wjh.v17.i10.110849.

Improved clinical outcomes following embolization of extrahepatic portosystemic shunts in cirrhotic patients with recurrent hepatic encephalopathy

Jong Won Park  1 , Yook Kim  2 , Jun Su Lee  1 , Il Soon Jung  3 , Ki Bae Kim  1 , Hee Bok Chae  4
Affiliations

Improved clinical outcomes following embolization of extrahepatic portosystemic shunts in cirrhotic patients with recurrent hepatic encephalopathy

Jong Won Park et al. World J Hepatol. .

Abstract

Background: Hepatic encephalopathy (HE) affects more than 30% of patients with cirrhosis. Extrahepatic portosystemic shunt (EHPSS) has been suggested to be a contributing factor to HE recurrence and mortality. Therefore, early detection and intervention in EHPSS may improve patient outcomes.

Aim: To evaluate the effects of shunt embolization on mortality and HE recurrence.

Methods: In this retrospective case-control study, 16 cirrhotic patients with HE treated at a tertiary care center from January 2012 to August 2022 were included. Outcomes in eight patients who underwent embolization of EHPSS were compared with those in eight patients receiving standard care without embolization. Data on baseline characteristics, HE recurrence, and overall survival were collected and analyzed using Kaplan-Meier and log-rank tests.

Results: Baseline characteristics were comparable between the groups. The 1-year overall survival rate was significantly higher in the treatment group (0.50) than in the control group (0.33). The HE recurrence-free rate was also higher in the treatment group (1.00) than in the control group (0.17). The median survival duration was longer in the treatment group {not reached [95% confidence interval (CI): 23.84 to not available (NA)]} than in the control group [15.02 months (95%CI: 9.86 to NA)] (P = 0.006). Similarly, the recurrence-free duration was longer in the treatment group [63.09 months (95%CI: 63.09 to NA)] than in the control group [9.21 months (95%CI: 4.47 to NA)] (P = 0.006). EHPSS embolization significantly reduced 1-year HE recurrence (hazard ratio = 0.09; 95%CI: 0.01-0.75; P = 0.026).

Conclusion: EHPSS embolization significantly improves 1-year survival and prevents recurrence of HE in cirrhotic patients. Routine computed tomography and early embolization are clinically beneficial.

Keywords: Embolization; Extrahepatic portosystemic shunt; Hepatic encephalopathy; Liver cirrhosis; Recurrence; Survival.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Consort diagram of patient selection. EHPSS: Extrahepatic portosystemic shunt; CTP: Child-Turcotte-Pugh; HCC: Hepatocellular carcinoma; HE: Hepatic encephalopathy.
Figure 2
Figure 2
Kaplan-Meier curves for overall survival and recurrence-free survival in patients with extrahepatic portosystemic shunt. A: Kaplan-Meier curves for overall survival in patients with extrahepatic portosystemic shunt; B: Kaplan-Meier curves for recurrence-free survival in patients with extrahepatic portosystemic shunt.
Figure 3
Figure 3
Angiographic images of splenorenal shunt embolization and mesocaval shunt embolization. A: After a 9-F vascular sheath was placed in the splenorenal shunt, the shunt was accessed coaxially using a 5-F cobra catheter; B: The vascular plug was deployed at the narrowest region of the splenorenal shunt through the vascular sheath and completion venography showed complete occlusion of the splenorenal shunt; C: Transhepatic superior mesenteric venogram showed the large size of mesocaval shunt; D: Coil placement showed complete closure of mesocaval shunt.
See this image and copyright information in PMC

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