Endoscopic Ultrasound-Guided Transgastric Shunt Obliteration for Recurrent Hepatic Encephalopathy
Sahaj Rathi, Amrita Kalantri, Arpit Shastri, Ritu Shree, Karthik Vinay Mahesh, Sunil Taneja, Sreedhara B. Chaluvasetty, Harish Bhujade, Nipun Verma, Madhumita Premkumar, Arka De, Naveen Kalra, Virendra Singh, Ajay Duseja
Abstract
INTRODUCTION: Occlusion of spontaneous portosystemic shunts (SPSSs) in patients with cirrhosis may be required in recurrent or refractory hepatic encephalopathy. We describe a novel method for occlusion of SPSS using endoscopic ultrasound (EUS). METHODS: EUS-guided transgastric shunt obliteration was performed by injecting glue and coils directly into SPSS. RESULTS: EUS-guided transgastric shunt obliteration was performed for 7 patients in 9 sessions. Complete cessation of Doppler flow was achieved in 6/7 cases. Adequate clinical response was observed in 6/7 patients. No procedure-related severe adverse events were seen. DISCUSSION: This novel technique is a potentially effective and efficient method for shunt obliteration.