Spontaneous portosystemic shunt diameter predicts liver function after balloon‐occluded retrograde transvenous obliteration
Akihisa Tatsumi, Shinya Maekawa, Leona Osawa, Ryo Katoh, Yasuyuki Komiyama, Natsuko Nakakuki, Hitomi Takada, Shuya Matsuda, Masaru Muraoka, Yuichiro Suzuki, Mitsuaki Sato, Ei Takahashi, Mika Miura, Fumitake Amemiya, Shinichi Takano, Mitsuharu Fukasawa, Tatsuya Yamaguchi, Yasuhiro Nakayama, Taisuke Inoue, Hiroki Okada, Takuji Araki, Hiroshi Onishi, Nobuyuki Enomoto
Abstract
Abstract Background and Aim Recently, balloon‐occluded retrograde transvenous obliteration (BRTO), performed for spontaneous portosystemic shunts (SPSS), has been receiving attention as a measure to improve liver function in cirrhotic patients with portal hypertension. However, it is unclear whether SPSS diameter is associated with changes in hepatic venous pressure gradient (HVPG) and liver function after BRTO. Methods In 34 cirrhotic patients receiving BRTO for hepatic encephalopathy/gastric varices, the association of SPSS diameter with liver function at baseline and 6 months after BRTO and the accompanying changes in HVPG were investigated. Results Patients had Child–Pugh (CP) scores of A/B/C (7/19/8), SPSS diameters of ≤10 mm/11–20 mm/<20 mm (8/21/5), and an average observation period of 3.2 (0.3–8.5) years. SPSS diameter was significantly associated with male sex, alcohol use, and values of albumin, prothrombin time (PT%), and NH 3 at baseline. Moreover, the SPSS diameter was significantly correlated with the changes in HVPG observed upon BRTO ( r = 0.55, P = 0.005), and a large shunt diameter was significantly associated with a greater increase in HVPG. At 6 months, significant improvements in albumin, PT%, bilirubin, and NH 3 were observed overall, but the improvement was marked in those with larger shunt diameters if they had CP A/B. Conclusion SPSS diameter was strongly associated with liver function at baseline and after BRTO and also with changes in HVPG, indicating that SPSS diameter is an important predictor of BRTO outcome.