Embolización de colaterales portosistémicas espontáneas como tratamiento de la encefalopatía hepática refractaria

Resumen

Background: Hepatic encephalopathy (HE) is a common complication of cirrhosis associated with a reduced survival. The presence of high-flux spontaneous porto-systemic shunts can induce HE even in patients with preserved liver function. Aim: To evaluate the effect of spontaneous porto-systemic shunt embolization (SPSE) over HE and its long-term evolution. Material and methods: Retrospective analysis of 11 patients aged 59 years (91% males) with severe HE non-responsive to medical treatment in whom a SPSE was performed. The grade of HE (employing West Haven score), survival, MELD and Child-Pugh score, ammonia levels, degree of disability (employing the modified Rankin scale (mRs)) were evaluated before and at thirty days after procedure. Results: The most common etiology found was non-alcoholic steatohepatitis (63.6%). A reduction of at least two score points of HE was observed in all patients after thirty days. There was a significant reduction on median (IQR) West Haven score from 3 (2–3) at baseline to 1 (0–1) after the procedure (p<0.01). Twelve months survival was 63.6%. There was a decrease in median ammonia level from 106.5 (79–165) (ug/dL) to 56 (43–61) after SPSE (p=0.006). The median mRS score before and after the procedure was 3 (3–5) and 1 (1–2.5) respectively (p<0.01). Conclusions: According to our experience, SPSE is a feasible and effective alternative to improve HE and functionality of patients with refractory EH.