Hepatic Encephalopathy Following Transjugular Intrahepatic Portosystemic Shunt (TIPS): Management with L-ornithine-L-aspartate and Stent Reduction

Overview

Journal Metab Brain Dis

Publisher Springer

Specialties Endocrinology
Neurology

Date 2006 Dec 14

PMID 17165154

Citations 3

Authors

Vanessa Stadlbauer

Josef Tauss

Horst R Portugaller

Philipp Stiegler

Florian Iberer

Rudolf E Stauber

Affiliations

Soon will be listed here.

Abstract

Hepatic encephalopathy (HE) is a common problem after insertion of a trans-jugular intrahepatic portosystemic shunt (TIPS), which may be difficult to manage. We present a case of severe post-TIPS HE unresponsive to high doses of L-ornithine-L-aspartate (LOLA) despite reduction of venous ammonia levels in a dose-dependent fashion. Ultimately, high-grade HE was successfully treated by a reduction stent and the patient subsequently underwent successful liver transplantation.

Citing Articles

Efficacy of covered and bare stent in TIPS for cirrhotic portal hypertension: A single-center randomized trial.

Wang L, Xiao Z, Yue Z, Zhao H, Fan Z, Zhao M Sci Rep. 2016; 6:21011.

PMID: 26876503 PMC: 4753460. DOI: 10.1038/srep21011.

The brain following transjugular intrahepatic portosystemic shunt: the perspective from neuroimaging.

Chen H, Zheng G, Wichmann J, Schoepf U, Lu G, Zhang L Metab Brain Dis. 2015; 30(6):1331-41.

PMID: 26404041 DOI: 10.1007/s11011-015-9735-4.

Hepatic encephalopathy: an updated approach from pathogenesis to treatment.

Toris G, Bikis C, Tsourouflis G, Theocharis S Med Sci Monit. 2011; 17(2):RA53-63.

PMID: 21278704 PMC: 3524698. DOI: 10.12659/msm.881387.

References

Rose C, Butterworth R, Zayed J, Normandin L, Todd K, Michalak A . Manganese deposition in basal ganglia structures results from both portal-systemic shunting and liver dysfunction. Gastroenterology. 1999; 117(3):640-4. DOI: 10.1016/s0016-5085(99)70457-9. View

Ochs A, Rossle M, Haag K, Hauenstein K, Deibert P, Siegerstetter V . The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites. N Engl J Med. 1995; 332(18):1192-7. DOI: 10.1056/NEJM199505043321803. View

Rose C, Michalak A, Pannunzio P, Therrien G, Quack G, Kircheis G . L-ornithine-L-aspartate in experimental portal-systemic encephalopathy: therapeutic efficacy and mechanism of action. Metab Brain Dis. 1998; 13(2):147-57. DOI: 10.1023/a:1020613314572. View

Hauenstein K, Haag K, Ochs A, Langer M, Rossle M . The reducing stent: treatment for transjugular intrahepatic portosystemic shunt-induced refractory hepatic encephalopathy and liver failure. Radiology. 1995; 194(1):175-9. DOI: 10.1148/radiology.194.1.7997547. View

Quiroga J, Sangro B, Nunez M, Bilbao I, Longo J, Zozaya J . Transjugular intrahepatic portal-systemic shunt in the treatment of refractory ascites: effect on clinical, renal, humoral, and hemodynamic parameters. Hepatology. 1995; 21(4):986-94. View

Riggio O, Merlli M, Pedretti G, Servi R, Meddi P, Lionetti R . Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Incidence and risk factors. Dig Dis Sci. 1996; 41(3):578-84. DOI: 10.1007/BF02282344. View

Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei A . Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002; 35(3):716-21. DOI: 10.1053/jhep.2002.31250. View

Ter Borg P, Hollemans M, van Buuren H, Vleggaar F, Groeneweg M, Hop W . Transjugular intrahepatic portosystemic shunts: long-term patency and clinical results in a patient cohort observed for 3-9 years. Radiology. 2004; 231(2):537-45. DOI: 10.1148/radiol.2312021797. View

Sanyal A, Genning C, Reddy K, Wong F, Kowdley K, Benner K . The North American Study for the Treatment of Refractory Ascites. Gastroenterology. 2003; 124(3):634-41. DOI: 10.1053/gast.2003.50088. View

10.

Luca A, DAmico G, La Galla R, Midiri M, Morabito A, Pagliaro L . TIPS for prevention of recurrent bleeding in patients with cirrhosis: meta-analysis of randomized clinical trials. Radiology. 1999; 212(2):411-21. DOI: 10.1148/radiology.212.2.r99au46411. View

11.

Blei A, Olafsson S, Therrien G, Butterworth R . Ammonia-induced brain edema and intracranial hypertension in rats after portacaval anastomosis. Hepatology. 1994; 19(6):1437-44. View

12.

Salerno F, Merli M, Riggio O, Cazzaniga M, Valeriano V, Pozzi M . Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites. Hepatology. 2004; 40(3):629-35. DOI: 10.1002/hep.20364. View

13.

Rose C, Michalak A, Rao K, Quack G, Kircheis G, Butterworth R . L-ornithine-L-aspartate lowers plasma and cerebrospinal fluid ammonia and prevents brain edema in rats with acute liver failure. Hepatology. 1999; 30(3):636-40. DOI: 10.1002/hep.510300311. View

14.

Lozeva V, Montgomery J, Tuomisto L, Rocheleau B, Pannunzio M, Huet P . Increased brain serotonin turnover correlates with the degree of shunting and hyperammonemia in rats following variable portal vein stenosis. J Hepatol. 2004; 40(5):742-8. DOI: 10.1016/j.jhep.2004.01.003. View

15.

Cordoba J, Dupuis J, Gottstein J, Blei A . Stenosis of a portacaval anastomosis affects circadian locomotor activity in the rat: a multivariable analysis. Am J Physiol. 1998; 273(6):G1218-25. DOI: 10.1152/ajpgi.1997.273.6.G1218. View

16.

Wong F, Sniderman K, Liu P, Allidina Y, Sherman M, Blendis L . Transjugular intrahepatic portosystemic stent shunt: effects on hemodynamics and sodium homeostasis in cirrhosis and refractory ascites. Ann Intern Med. 1995; 122(11):816-22. DOI: 10.7326/0003-4819-122-11-199506010-00002. View

17.

Saab S, Nieto J, Ly D, Runyon B . TIPS versus paracentesis for cirrhotic patients with refractory ascites. Cochrane Database Syst Rev. 2004; (3):CD004889. DOI: 10.1002/14651858.CD004889. View

18.

Stauch S, Kircheis G, Adler G, Beckh K, DITSCHUNEIT H, Gortelmeyer R . Oral L-ornithine-L-aspartate therapy of chronic hepatic encephalopathy: results of a placebo-controlled double-blind study. J Hepatol. 1998; 28(5):856-64. DOI: 10.1016/s0168-8278(98)80237-7. View

19.

Lebrec D, Giuily N, Hadengue A, Vilgrain V, Moreau R, Poynard T . Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial. French Group of Clinicians and a Group of Biologists. J Hepatol. 1996; 25(2):135-44. DOI: 10.1016/s0168-8278(96)80065-1. View

20.

Als-Nielsen B, Gluud L, Gluud C . Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials. BMJ. 2004; 328(7447):1046. PMC: 403844. DOI: 10.1136/bmj.38048.506134.EE. View