ethamolin and Hepatic-Encephalopathy

This study was conducted to evaluate changes in liver stiffness, volume, and function before and after occlusion of spontaneous portosystemic shunt.. Twenty-four patients (13 men and 11 women) with a mean age of 68.2 years±10.1 (SD) (age range, 49-82 years) underwent percutaneous occlusion of spontaneous portosystemic shunt because of gastric varices (n=17) or hepatic encephalopathy (n=7) from March 2011 to June 2013. The liver fibrosis index indicating liver stiffness was calculated by using ultrasound elastography before and after shunt occlusion. Liver volume and liver profile were also evaluated.. Spontaneous portosystemic shunt occlusion was uneventfully performed in all patients. The mean liver fibrosis index was significantly decreased from 2.7±1.0 before shunt occlusion to 2.0±0.9 (P<0.001) at 1 month, 2.2±1.0 at 3 months (P=0.004), and 1.6±0.7 at 6 months (P=0.001) afterwards. A significant increase in the liver volume was observed from 1035.3±340.1mL before shunt occlusion to 1116.8±298.4mL (P=0.006) at 1 month and 1174.2±354.1mL (P<0.001) at 3 months afterwards. Significant improvement in the Child-Pugh score was also found at 1 month (6.2±1.4, P<0.001), 3 months (6.5±1.1, P=0.022), and 6 months (6.0±0.9, P=0.004) after shunt occlusion as compared with that (7.2±1.9) before.. The liver stiffness decreases along with an increase in liver volume and improvement in liver function after spontaneous portosystemic shunt occlusion.

Topics: Aged; Aged, 80 and over; Elasticity Imaging Techniques; Esophageal and Gastric Varices; Female; Follow-Up Studies; Hepatic Encephalopathy; Humans; Liver Cirrhosis; Liver Function Tests; Male; Middle Aged; Oleic Acids; Organ Size; Portasystemic Shunt, Surgical; Prognosis; Retrospective Studies

Balloon-occluded retrograde transvenous obliteration (B-RTO) is an effective treatment for gastric varices (GVx), as well as hepatic encephalopathy. The aim of this study was to examine the changes of the hepatic vein pressure gradient (HVPG) after B-RTO and determine the relation between the changes of HVPG and liver function.. B-RTO was performed in 30 patients with GVx and hepatic encephalopathy. HVPG was measured in 19 of 30 patients both before and after B-RTO.. The B-RTO was successful in all patients. The GVx and hepatic encephalopathy were improved, and no recurrence or bleeding was observed within the follow- up period. The serum albumin and prothrombin activity were significantly improved 6 months after B-RTO in all patients. HVPG was elevated 44% above the baseline after B-RTO. Liver function significantly improved 6 months after B-RTO in patients whose HVPG increased ≥ 20% from baseline.. An elevated HVPG after B-RTO is one aspect of the effect of liver function, and an HVPG increase of ≥ 20% from baseline is a predictive factor for obtaining an improvement of liver function.

Topics: Aged; Balloon Occlusion; Biomarkers; Esophageal and Gastric Varices; Female; Hepatic Encephalopathy; Hepatic Veins; Humans; Japan; Liver; Liver Function Tests; Male; Middle Aged; Oleic Acids; Prothrombin; Recovery of Function; Sclerosing Solutions; Sclerotherapy; Serum Albumin; Time Factors; Treatment Outcome; Venous Pressure

We describe a technique for the treatment of hepatic encephalopathy in a cirrhotic patient with a large spontaneous splenorenal shunt. This large shunt was successfully occluded without severe complications by retrograde transrenal venous obliteration with ethanolamine oleate after balloon occlusion. This procedure may be an effective method to occlude a large spontaneous splenorenal shunt for the treatment of hepatic encephalopathy.

Topics: Aged; Female; Hepatic Encephalopathy; Humans; Liver Circulation; Liver Cirrhosis; Oleic Acids; Renal Veins; Sclerosing Solutions; Splenic Vein; Surgical Procedures, Operative