THE EFFECTS OF PORTAL PRESSURE CHANGE BY TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT AND SHUNT STENOSIS ON PORTAL HYPERTENSIVE GASTROPATHY

Abstract

We evaluated the effect of reduction of portal venous pressure by placement of transjugular intrahepatic porto-systemic shunt (TIPS) on portal hypertensive gastropathy (PHG). Among 24 cirrhotic patients, nine complicated with PHG were well improved within two weeks after the TIPS treatment and four with severe, uncontrolled bleeding due to PHG were all managed to stop the bleeding by that treatment. During the follow up period of around 506 days, percutaneous transluminal angioplasty (PTA) had to be performed for 19 patients because of shunt dysfunction. Seven out of 16 patients who were free from PHG after TIPS suffered again from PHG with the appearance of shunt dysfunction. Among seven PHG positive patients, 6 could be controlled by PTA treatment. Thus, PHG can be controlled either by TIPS or PTA through the reduction of portal venous pressure. In particular, TIPS is effective to control bleeding from PHG. As long as we have investigated, there were no significant difference in portal venous pressure between PHG positive patients and negative ones. These results suggest that other factors except portal hypertension should be considered to explain the mechanism of PHG occurrence.