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Inicio Annals of Hepatology P-39 EXPERIENCE IN THE MANAGEMENT OF REFRACTORY HEPATIC ENCEPHALOPATHY THROUGH E...
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Vol. 24. Núm. S1.
Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)
(septiembre 2021)
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Vol. 24. Núm. S1.
Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)
(septiembre 2021)
Open Access
P-39 EXPERIENCE IN THE MANAGEMENT OF REFRACTORY HEPATIC ENCEPHALOPATHY THROUGH ENDOVASCULAR THERAPY
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Claudia Muñoz1, Felipe Ramírez1, Nicolás Martínez2, Patricio Palavecino2, Claudia Pavez3, Alvaro Urzúa1, Máximo Cattaneo1, Juan Pablo Roblero1, Jaime Poníachik1
1 Sección de Gastroenterología, Departamento de Medicina Interna, Hospital Clínico Universidad de Chile, Santiago, Chile
2 Servicio de Imagenología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
3 Departamento de Gastroenterología Clínica Dávila, Santiago, Chile
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Vol. 24. Núm S1

Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)

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Introduction

Hepatic encephalopathy (HE) is the most common neuropsychiatric syndrome secondary to portal hypertension. It usually responds to medical treatment, but sometimes HE is refractory (RHE) to usual treatment. In some patients it may be important to consider management alternatives. Endovascular therapy (ET) could be a therapeutic option in selected cases that is performed with very low frequency and the evidence is scarce.

Objectives

To present our experience in the management of RHE with ET.

Methods

The pre and post-procedure clinical characteristics of 10 patients with RHE undergoing splenic vein embolization (n: 5) or porto-systemic bypass embolization (n: 5) between 2009-2019 were retrospectively analyzed.

Results

7/10 were men, average age 67 years (62-79), in 70% the cause of cirrhosis was NASH, the Child Pugh average score was B (8 points), (6-11) and MELD-Na was 13 points, (9-20), in 5 patients the ammonia prior to the procedure was 134 mmol / l (range: 90-180, VN <30), the average degree of HE was 2-3 on the scale of West Haven. One week after the procedure, in all patients the grade of EH decreased to 0-1 and the ammonium to 88 mmol / l. At one month, the grade of HE was 0 in all patients and that of ammonia was 83 mmol / l. There were no complications from the procedure.

Conclusion

The results obtained confirm that ET in patients with Child B HE and MELD-Na maximum of 20 is a safe and effective procedure, associated with clinical improvement in RHE.

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