Spontaneous portosystemic shunt diameter predicts liver function after balloon-occluded retrograde transvenous obliteration

Akihisa Tatsumi; Shinya Maekawa; Leona Osawa; Ryo Katoh; Yasuyuki Komiyama; Natsuko Nakakuki; Hitomi Takada; Shuya Matsuda; Masaru Muraoka; Yuichiro Suzuki; Mitsuaki Sato; Ei Takahashi; Mika Miura; Fumitake Amemiya; Shinichi Takano; Mitsuharu Fukasawa; Tatsuya Yamaguchi; Yasuhiro Nakayama; Taisuke Inoue; Hiroki Okada; Takuji Araki; Hiroshi Onishi; Nobuyuki Enomoto

doi:10.1002/jgh3.12712

Spontaneous portosystemic shunt diameter predicts liver function after balloon-occluded retrograde transvenous obliteration

JGH Open. 2022 Jan 28;6(2):139-147. doi: 10.1002/jgh3.12712. eCollection 2022 Feb.

Authors

Akihisa Tatsumi¹, Shinya Maekawa¹, Leona Osawa¹, Ryo Katoh¹, Yasuyuki Komiyama¹, Natsuko Nakakuki¹, Hitomi Takada¹, Shuya Matsuda¹, Masaru Muraoka¹, Yuichiro Suzuki¹, Mitsuaki Sato¹, Ei Takahashi¹, Mika Miura¹, Fumitake Amemiya¹, Shinichi Takano¹, Mitsuharu Fukasawa¹, Tatsuya Yamaguchi¹, Yasuhiro Nakayama¹, Taisuke Inoue¹, Hiroki Okada², Takuji Araki², Hiroshi Onishi², Nobuyuki Enomoto¹

Affiliations

¹ First Department of Internal Medicine, Faculty of Medicine University of Yamanashi Yamanashi Japan.
² Department of Radiology, Faculty of Medicine University of Yamanashi Yamanashi Japan.

Abstract

Background and aim: Recently, balloon-occluded retrograde transvenous obliteration (BRTO), performed for spontaneous portosystemic shunts (SPSS), has been receiving attention as a measure to improve liver function in cirrhotic patients with portal hypertension. However, it is unclear whether SPSS diameter is associated with changes in hepatic venous pressure gradient (HVPG) and liver function after BRTO.

Methods: In 34 cirrhotic patients receiving BRTO for hepatic encephalopathy/gastric varices, the association of SPSS diameter with liver function at baseline and 6 months after BRTO and the accompanying changes in HVPG were investigated.

Results: Patients had Child-Pugh (CP) scores of A/B/C (7/19/8), SPSS diameters of ≤10 mm/11-20 mm/<20 mm (8/21/5), and an average observation period of 3.2 (0.3-8.5) years. SPSS diameter was significantly associated with male sex, alcohol use, and values of albumin, prothrombin time (PT%), and NH₃ at baseline. Moreover, the SPSS diameter was significantly correlated with the changes in HVPG observed upon BRTO (r = 0.55, P = 0.005), and a large shunt diameter was significantly associated with a greater increase in HVPG. At 6 months, significant improvements in albumin, PT%, bilirubin, and NH₃ were observed overall, but the improvement was marked in those with larger shunt diameters if they had CP A/B.

Conclusion: SPSS diameter was strongly associated with liver function at baseline and after BRTO and also with changes in HVPG, indicating that SPSS diameter is an important predictor of BRTO outcome.

Keywords: balloon‐occluded retrograde transvenous obliteration; hepatic venous pressure gradient; liver function; spontaneous portosystemic shunt diameter.