Balloon-occluded retrograde transvenous obliteration for hepatic encephalopathy

Abstract

We performed balloon-occluded retrograde transvenous obliteration (B-RTO) in 14 consecutive patients with hepatic encephalopathy which was refractory to conservative treatment. Ten of these patients underwent additional partial splenic embolization (PSE) to block the increase in portal venous pressure following B-RTO. The targeted portosystemic shunts were gasterorenal shunts in seven, splenorenal shunts in five, mesocaval shunts in three, azygos system in one, and paraumbilical vein in one, respectively. B-RTO was successfully per formed in 12 of 14 patients (85.7%). In the successfully treated patients, hepatic encephalopathy improved and serum venous ammonia levels decreased significantly. These patients were subsequently able to care for themselves and return to normal social life. Parameters of residual hepatic reserve (serum albumin level, ICG disappearance rate (ICG-k), and Child-Pugh score) were significantly improved after B-RTO. Long-term ammonia levels increased again in some cases, and encephalopathy recurred in three cases. Important issues such as identifying the factors which affect outcome, and variety of locations of newly developed portosystemic shunts after B-RTO should be further studied.