Improved clinical outcomes following embolization of extrahepatic portosystemic shunts in cirrhotic patients with recurrent hepatic encephalopathy

BACKGROUND Hepatic encephalopathy (HE) affects more than 30% of patients with cirrhosis. Extrahepatic portosystemic shunt (EHPSS) has been suggested to be a contributing factor to HE recurrence and mortality. Therefore, early detection and intervention in EHPSS may improve patient outcomes. AIM To evaluate the effects of shunt embolization on mortality and HE recurrence. METHODS In this retrospective case-control study, 16 cirrhotic patients with HE treated at a tertiary care center from January 2012 to August 2022 were included. Outcomes in eight patients who underwent embolization of EHPSS were compared with those in eight patients receiving standard care without embolization. Data on baseline characteristics, HE recurrence, and overall survival were collected and analyzed using Kaplan-Meier and log-rank tests. RESULTS Baseline characteristics were comparable between the groups. The 1-year overall survival rate was significantly higher in the treatment group (0. 50) than in the control group (0. 33). The HE recurrence-free rate was also higher in the treatment group (1. 00) than in the control group (0. 17). The median survival duration was longer in the treatment group not reached 95% confidence interval (CI): 23. 84 to not available (NA) than in the control group 15. 02 months (95%CI: 9. 86 to NA) (P = 0. 006). Similarly, the recurrence-free duration was longer in the treatment group 63. 09 months (95%CI: 63. 09 to NA) than in the control group 9. 21 months (95%CI: 4. 47 to NA) (P = 0. 006). EHPSS embolization significantly reduced 1-year HE recurrence (hazard ratio = 0. 09; 95%CI: 0. 01-0. 75; P = 0. 026). CONCLUSION EHPSS embolization significantly improves 1-year survival and prevents recurrence of HE in cirrhotic patients. Routine computed tomography and early embolization are clinically beneficial.