Portal hypertension (PH) in cirrhosis is the result of resistance to portal blood
flow and may lead, once the portal pressure gradient rises to 10 mmHg or greater,
to complications such as variceal bleeding and ascites [
1
,
2
]. Another consequence of PH is the appearance of spontaneous portosystemic shunts
(SPSS) [
[3]
], leading to an increased risk of hepatic encephalopathy (HE) and also hepatic dysfunction
by diminishing hepatic portal-venous perfusion [
[4]
]. Although SPSS have long been considered as a compensatory decompressing mechanism
for increasing portal pressure, recent evidence indicates that SPSS are indirect markers
of greater liver complications and mortality [
[5]
]. Transjugular intrahepatic portosystemic shunts (TIPS) have been proven to be an
effective treatment for cirrhotic patients with recurrent or uncontrolled variceal
bleeding and refractory ascites [
6
,
7
,
8
,
9
], but again this is not free from complications such as deterioration of hepatic function
and/or HE [
[10]
]. Therefore, in patients with TIPS and co-existing SPSS, the presence of both shunts
may induce excessive portosystemic shunting and severe HE. Moreover, it is not clear
whether the presence of pre-existing SPSS in cirrhotic patients who require TIPS influences
outcomes after TIPS placement.To read this article in full you will need to make a payment
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References
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Article info
Publication history
Published online: July 02, 2018
Accepted:
June 18,
2018
Received in revised form:
June 18,
2018
Received:
June 7,
2018
Footnotes
☆Title of the manuscript that is commented: Association between non-variceal spontaneous portosystemic shunt and outcomes after TIPS in cirrhosis. Authors of the manuscript that is commented: Chuangye He, Yong Lv, Zhengyu Wang, Wengang Guo, Jun Tie, Kai Li, Jing Niu, Luo zuo, Tianlei Yu, Xulong Yuan, Hui Chen, Qiuhe Wang, Haibo Liu, Wei Bai, Enxing Wang, Dongdong Xia, Bohan Luo, Xiaomei Li, Jie Yuan, Na Han, Ying Zhu, Jianhong Wang, Zhanxin Yin, Daiming Fan, Guohong Han.
Identification
Copyright
© 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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