Patients with decompensated cirrhosis are at the high risk for rehospitalization even when hepatic encephalopathy attenuated during the admission. Thus, the survival rates and rehospitalization rates were evaluated in patients with hepatic encephalopathy retrospectively, and factors associated with the readmission were identified. Subjects were a total of 85 consecutive cirrhotic patients diagnosed as having hepatic encephalopathy and hospitalized in our hospital from January 2009 to June 2017. They consisted of 42 men and 43 women, with a median age of 73.7 years, and the Child-Pugh class C liver damage and hepatocellular carcinoma (HCC) were seen in 64 patients and 29 patients, respectively. During the median follow-up period for 178 days, 14 patients died during the hospitalization, Of 71 patients achieving discharge from the hospital, 51 patients were readmitted for the treatment of recurrent hepatic encephalopathy. The cumulative rehospitalization rates at 1 and 3 months were 27.4％ and 45.8％, respectively. Univariate analysis demonstrated that the Child-Pugh score of 12 or more (p＝0.007) and presence of HCC were factors associated with the readmission (p＝0.007 and p＝0.04, respectively). Multivariate analysis, however, revealed that the Child-Pugh score of 12 or more as an exclusive significant factor associated with the readmission (HR＝2.26, 95％CI 1.28-3.99, p＝0.005). The cumulative survival rate of these patients was 49.7％ at 1 year, and the outcome of those with HCC was unfavorable than in the remaining patients (p＜0.001). Cirrhotic patients who achieve discharge from the hospital following attenuation of hepatic encephalopathy should be observed carefully to prevent readmission due to recurrent encephalopathy.

Aim of this study was to evaluate newly designed method to predict change in portal venous pressure (PVP) after partial splenic embolization (PSE). Subjects were 13 patients receiving PSE in whom free hepatic venous pressure (fHVP), wedged hepatic venous pressure (WHVP) and hepatic venous pressure gradient (HVPG) were measured before and after the prodedure. Splenic infarction rate (SIR) was measured on contrast-enhanced CT images between 1 and 3 weeks after PSE. Diameters of the celiac artery (CA), superior mesenteric artery (SMA), common hepatic artery (CHA) and splenic arteries (SA) were measured on contrast-enhanced CT images before PSE. The hemodynamics model for estimation of PVP was established under the following conditions: PVP was determined by blood flows through CA and SMA and the ratio of each flow was correlated with a diameter of each artery to the power of x (x＝4, 3, 2.33, 2 by fluid mechanics). Blood flows in SA and CHA were equivalent to that of CA and the ratio of SA flow and CAH flow relative to CA flow were determined as was in the ratio of CA flow and SMA flow, blood flow of SA decreased depending on SIR. Estimated ratios of decrease in PVP were compared to the ratios of decrease in HVPG after PSE procedures. Consequently, the average SIR was 57.5% and the decrease of HVPG after PSE relative to than at baseline was 2.7 mmHg, suggesting that the mean ratio of decrease in HVPG was 19% (SD: 8%). In contrast, mean estimated ratios of decrease in PVP after PSE was calculated as 23% (SD: 5%) when x value was set as 2, which shows significant correlation to the ratio of decrease in HVPG (p＝0.046). Thus, decrease in PVP can be estimated based on diameters of CA, SMA, SA and CHA before PSE and SIR after PSE.

In this study, a survey for incidental injuries developing during and after the therapies for portal hypertension were conducted. Patients receiving endoscopic therapies and interventional radiological therapies from January 1, 2016 to December 31, 2017 and those receiving surgical therapies from January 1, 2015 to December 31, 2017 were enrolled. We report on the frequency of procedural accidents in relation to the number of each therapies.