Segmental intrahepatic cholestasis as a technical complication of the transjugular intrahepatic porto-systemic shunt  

作　　者：Julian Nikolaus Bucher Marcus Hollenbach Steffen Strocka Gereon Gaebelein Michael Moche Thorsten Kaiser Michael Bartels Albrecht Hoffmeister 

机构地区：[1]Department of Surgery,Munich University Hospital at Groβhadern,Bavaria,Munich 81377,Germany [2]Medical Department Ⅱ-Gastroenterology,Hepatology,Infectious Diseases,Pulmonology,University of Leipzig Medical Center,Saxony,Leipzig 04103,Germany [3]Department of Diagnostic and Interventional Radiology,University of Leipzig Medical Center,Saxony,Leipzig 04103,Germany [4]Department of General,Visceral,Vascular and Pediatric Surgery,University of Saarland,Saarland,Homburg 66421,Germany [5]Department of Diagnostic and Interventional Radiology,Bavaria,Nuernberg 90411,Germany [6]Institute of Laboratory Medicine,Clinical Chemistry and Molecular Diagnostics,University of Leipzig Medical Center,Saxony,Leipzig 04310,Germany [7]Department for General and Visceral Surgery,Helios Park-Klinikum Leipzig,Saxony,Leipzig 04289,Germany [8]Medical Department Ⅱ-Gastroenterology,Hepatology,Infectious Diseases,Pulmonology,University of Leipzig Medical Center,Leipzig 04103,Saxony,Germany

出　　处：《World Journal of Gastroenterology》2019年第43期6430-6439,共10页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND Segmental intrahepatic cholestasis caused by transjugular intrahepatic portosystemic shunt(TIPS)(SIC-T),is a rare complication of this technique and only referred by case reports.Thus,we conducted a systematic,retrospective analysis to provide evidence regarding prevalence and consequences of this TIPS-induced bile duct compression.AIM To assess prevalence and outcome of SIC-T in a large TIPS-cohort.METHODS In this retrospective cohort study,we screened the institutional databases for all consecutive patients that were treated by TIPS-placement or TIPS-revision between January 2005 and August 2013.We analyzed radiologic images for signs of biliary congestion.Cases that were indicative of SIC-T were reviewed by two independent radiologists and additional patient data was collected.Descriptive statistics of patient demographics,indications for TIPS and procedural details were registered.Logistic regression analysis was performed to identify predictors for the development of SIC-T.RESULTS We analyzed 135 cirrhotic patients who underwent TIPS(mean age 55 years,79%male gender).Etiology of cirrhosis was alcohol in most cases and indications for TIPS were mainly refractory ascites and recurrent variceal bleeding.TIPS revision was necessary in 31 patients.We identified 4 cases(2.9%)of SIC-T in direct proximity of the TIPS-stent.Diagnosis was confirmed by CT-scan,MRI or endoscopic retrograde cholangio pancreaticography(ERCP).In two patients TIPS was implanted via the right and in one through the medial hepatic vein.One patient received TIPS-prolongation by multiple revisions.Most patients were asymptomatic but one cholangitic abscess necessitated a transhepatic drain.Logistic regression analysis identified TIPS-placement other than from medial hepatic vein to right portal vein as risk factor(OR 21.0)for SIC-T.CONCLUSION SIC-T ads to(mostly late)complications in the interventional treatment of cirrhotic portal hypertensions and can lead to cholangitic abscesses.Patients,particularly with multiple interventions,sBACKGROUND Segmental intrahepatic cholestasis caused by transjugular intrahepatic portosystemic shunt(TIPS)(SIC-T), is a rare complication of this technique and only referred by case reports. Thus, we conducted a systematic, retrospective analysis to provide evidence regarding prevalence and consequences of this TIPS-induced bile duct compression.AIM To assess prevalence and outcome of SIC-T in a large TIPS-cohort.METHODS In this retrospective cohort study, we screened the institutional databases for all consecutive patients that were treated by TIPS-placement or TIPS-revision between January 2005 and August 2013. We analyzed radiologic images for signs of biliary congestion. Cases that were indicative of SIC-T were reviewed by two independent radiologists and additional patient data was collected. Descriptive statistics of patient demographics, indications for TIPS and procedural details were registered. Logistic regression analysis was performed to identify predictors for the development of SIC-T.RESULTS We analyzed 135 cirrhotic patients who underwent TIPS(mean age 55 years, 79%male gender). Etiology of cirrhosis was alcohol in most cases and indications for TIPS were mainly refractory ascites and recurrent variceal bleeding. TIPS revision was necessary in 31 patients. We identified 4 cases(2.9%) of SIC-T in direct proximity of the TIPS-stent. Diagnosis was confirmed by CT-scan, MRI or endoscopic retrograde cholangio pancreaticography(ERCP). In two patients TIPS was implanted via the right and in one through the medial hepatic vein. One patient received TIPS-prolongation by multiple revisions. Most patients were asymptomatic but one cholangitic abscess necessitated a transhepatic drain.Logistic regression analysis identified TIPS-placement other than from medial hepatic vein to right portal vein as risk factor(OR 21.0) for SIC-T.CONCLUSION SIC-T ads to(mostly late) complications in the interventional treatment of cirrhotic portal hypertensions and can lead to cholangitic abscesses. Patients,particularly with m

关 键 词：Transjugular intrahepatic portosystemic shunt Cirrhosis ASCITES BLEEDING CHOLESTASIS Biliary congestion 

分 类 号：R57[医药卫生—消化系统]