Impact of transjugular intrahepatic portosystemic shunt on post-colectomy complications in patients with ulcerative colitis and primary sclerosing cholangitis

Gursimran Kochhar; Udayakumar Navaneethan; Jose Mari Parungao; Jason Hartman; Ranjan Gupta; Rocio Lopez; Arthur J McCullough; Baljiendra Kapoor; Bo Shen

doi:10.1093/gastro/gou085

Impact of transjugular intrahepatic portosystemic shunt on post-colectomy complications in patients with ulcerative colitis and primary sclerosing cholangitis

Gastroenterol Rep (Oxf). 2015 Aug;3(3):228-33. doi: 10.1093/gastro/gou085. Epub 2014 Dec 16.

Authors

Gursimran Kochhar¹, Udayakumar Navaneethan¹, Jose Mari Parungao¹, Jason Hartman², Ranjan Gupta¹, Rocio Lopez¹, Arthur J McCullough¹, Baljiendra Kapoor³, Bo Shen⁴

Affiliations

¹ Department of Gastroenterology and Hepatology, The Cleveland Clinic, Cleveland, OH, USA.
² Case Western Reserve University School of Medicine, Cleveland, OH, USA.
³ Department of Vascular and Interventional Radiology, The Cleveland Clinic, Cleveland, OH, USA.
⁴ Department of Gastroenterology and Hepatology, The Cleveland Clinic, Cleveland, OH, USA Shenb@ccf.org.

Abstract

Objective: Primary sclerosing cholangitis (PSC) occurs in approximately 5% of patients with ulcerative colitis (UC). The risk of colon cancer is higher in patients undergoing colectomy, who have simultaneous PSC & UC. Our aim was to study the impact, in terms of post-colectomy survival and complications, of transjugular intrahepatic portosystemic shunt (TIPS) before colectomy in these patients.

Methods: In this retrospective, case-control study, information was obtained on demographics, disease characteristics, TIPS characteristics, and post-colectomy complications. Nine patients with PSC and UC who underwent TIPS prior to colectomy (the Study group) and 37 patients with PSC and UC who underwent only colectomy without TIPS (the Control group) were included. Either an analysis of variance or the non-parametric Kruskal-Wallis test were used for continuous variables and Fisher's Exact test or Pearson's chi-squared test was used for categorical factors.

Results: There was no difference in the mean age between the two groups; however patients in the Study group had lower platelet count (P = 0.005) as well as higher Model for End- Stage Liver disease (MELD) scores (P < 0.001). Also, patients in the Study group had increased PSC severity as determined by Mayo PSC Risk Scores (1.50 vs. 0.20) (P = 0.001). Total bilirubin levels were higher in the Study group (2.3 vs. 0.8 mg/dL) (P = 0.011). Comparing the post-operative complication rates without adjusting for disease severity, the Study group had more wound infections (P = 0.034), more wound dehiscence (P = 0.022), and a higher re-admission rate within 30 days (P = 0.032); however, the post-operative mortality was not significantly different.

Conclusion: Patients with PSC and UC who underwent TIPS prior to colectomy had higher rates of complications; however, this was probably due to the greater severity of cirrhosis and PSC in this population.

Keywords: colectomy; primary sclerosing cholangitis; transjugular intrahepatic portosystemic shunt (TIPS); ulcerative colitis.