Evaluation of impact of elective invasive examinations in patients with transjugular intrahepatic portosystemic shunt in the long-term follow up

Leon Louis Seifert; Dennis Görlich; Christian Jansen; Olessja Ortmann; Martin Schoster; Michael Praktiknjo; Wenyi Gu; Philipp Schindler; Michael Köhler; Miriam Maschmeier; Christian Wilms; Carsten Meyer; Hartmut H. Schmidt; Moritz Wildgruber; Jonel Trebicka; Hauke Heinzow

doi:10.1055/a-1330-9867

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2021; 59(01): 24-34
DOI: 10.1055/a-1330-9867

Originalarbeit

Evaluation of impact of elective invasive examinations in patients with transjugular intrahepatic portosystemic shunt in the long-term follow up

Der Einfluss elektiver invasiver Kontrollen in Patienten mit transjugulärem intrahepatischem portosystemischen Shunt im Langzeit-follow-up

Leon Louis Seifert

¹Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology, University Hospital Muenster, Muenster, Germany

,

Dennis Görlich

²Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany

,

Christian Jansen

³Department of Internal Medicine I, University of Bonn, Bonn, Germany

,

Olessja Ortmann

¹Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology, University Hospital Muenster, Muenster, Germany

,

Martin Schoster

¹Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology, University Hospital Muenster, Muenster, Germany

,

Michael Praktiknjo

³Department of Internal Medicine I, University of Bonn, Bonn, Germany

,

Wenyi Gu

⁴Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany

,

Philipp Schindler

⁵Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany

,

Michael Köhler

⁵Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany

,

Miriam Maschmeier

¹Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology, University Hospital Muenster, Muenster, Germany

,

Christian Wilms

¹Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology, University Hospital Muenster, Muenster, Germany

,

Carsten Meyer

⁶Institute of Radiology, University of Bonn, Bonn, Germany

,

Hartmut H. Schmidt

¹Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology, University Hospital Muenster, Muenster, Germany

,

Moritz Wildgruber

⁵Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany

⁷Department of Radiology, University Hospital Ludwig-Maximilians-Universität – Campus Großhadern, Munich, Germany

,

Jonel Trebicka

⁴Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany

,

Hauke Heinzow

¹Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology, University Hospital Muenster, Muenster, Germany

› Author Affiliations

Abstract

Introduction In the management of patients with decompensated liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) insertion is well-established but common recommendations in the follow up management are inconsistent. Doppler sonography is commonly used for detection for TIPS dysfunction whilst data on the impact of elective invasive examinations are scarce.

Aim The aim of this retrospective analysis is to evaluate potential benefits of elective invasive examinations in the follow up management of patients after TIPS insertion

Methods Data of all patients receiving TIPS at the university hospitals of Muenster and Bonn between 2013 and 2018 (n = 534) were collected. The impact of performance of elective invasive examinations at 12 months after TIPS insertion on the occurrence of liver related events (LREs) and frequency of TIPS revisions within 24 months after TIPS insertion was analyzed.

Results No significant differences were found concerning occurrence of liver related events after 24 months depending on whether an elective invasive examination was performed. Occurrence of hepatic encephalopathy, relapse of initial indication for TIPS, as well as death or liver transplantation all did not differ. These findings were verified by a subgroup analysis including only patients who did not experience a LRE or TIPS revision within the first 12 months after TIPS procedure.

Conclusion The analyzed data suggest no evidence for a beneficial impact due to implementation of an elective invasive examination program after TIPS insertion. Invasive examinations should remain reserved to patients with suspected TIPS dysfunction.

Zusammenfassung

Einleitung Die Anlage eines transjugulären intrahepatischen portosystemischen Shunts ist ein etabliertes Verfahren in Patienten mit dekompensierter Leberzirrhose, es fehlen jedoch einheitlich Empfehlungen in der Patientennachsorge. Die Doppler-Sonografie wird regelhaft zur Kontrolle des Shunts genutzt. Aktuell gibt es keine Daten in Bezug auf elektive invasive Kontrollen.

Ziel Ziel dieser retrospektiven Arbeit ist die Evaluation des Einflusses elektiver invasiver TIPS-Kontrollen in der Patientennachsorge.

Methoden Es wurden Daten aller Patienten, die eine TIPS Implantation an den Universitätskliniken Münster und Bonn zwischen 2013 und 2018 erhalten haben, erhoben. Der Einfluss elektiver invasiver Kontrollen zwölf Monate nach TIPS Implantation bezüglich des Auftretens leber-assoziierter Ereignisse sowie der Häufigkeit von Shunt-Revisionen wurde analysiert.

Ergebnisse Es zeigten sich keine signifikanten Unterschiede bezüglich Leber-assoziierter Ereignisse nach 24 Monaten. Unterschiede bezüglich der Häufigkeit von Episoden hepatischer Enzephalopathien, einer Rekurrenz der initialen TIPS-Indikation, sowie Todesfällen oder Lebertransplantationen konnten nicht nachgewiesen werden. In einer Subgruppen-Analyse wurden nur Patienten, die innerhalb der ersten zwölf Monate kein leber-assoziiertes Ereignis oder eine TIPS-Revision hatten, analysiert: Auch hier wurden keine Unterschiede festgestellt.

Schlussfolgerung Unsere Daten zeigen keinen Vorteil für Patienten durch die Implementierung elektiver invasiver Kontrollen. Invasive Kontrollen sollten Patienten mit Hinweisen auf eine Shunt-Dysfunktion vorbehalten werden.

Key words

Liver - TIPS - complications of liver cirrhosis - hepatic decompensation

Schlüsselwörter

Leber - TIPS - Komplikationen der Leberzirrhose - Hepatische Dekompensation

Full Text

References

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