Current Diagnosis And Management Of Post-transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy

Transjugular intrahepatic portosystemic shunt(TIPS)is one of the minimally invasived interventional procedures,which has evolved into an important option for management of complications of portal hypertension,since the use of covered stent and improvement of the stent patency.It has been used to treat some of the complications of portal hypertension,especially cirrhosis accompanying with esophagogastric variceal bleeding(EVB),ascites refractory,Budd-Chiari syndrome,portal hypertensive gastropathy,hepatic hydrothorax,the transitional treatment before liver transplantation and so on.TIPS can reduce effectively portal pressure and the risk of EVB or refractory ascites,but it also decrease flow to the liver perfusion and aggravate the damage to liver function,which will lead to the hydrodynamic shunt encephalopathy finally.The patient,who sufferd refractory hepatic encephalopathy after TIPS has low quality of life,poor prognosis,or high mortality.However,there is no radical treatment for it at present,so the preventon of it should be put firstly in medical work.Patient selection for TIPS requires careful evaluation of risk factors for HE in order to reduce the incidence of Hepatic encephalopathy after TIPS.Currently,the diagnosis and treatment of post-TIPS HE remains to be a challenge in clinical practice.The purpose of this article is to make a brief summary of latest consensus on the pathogenesis,related factors,diagnosis and treatment of post-TIPS HE,so as to improve the recognition of HE and formulate the strategy for the diagnosis and treatment of post-TIPS HE.