TIPS and splenorenal shunt for complications of portal hypertension in chronic hepatosplenic schistosomiasis-A case series and review of the literature.

Autor: Nordmann T; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; German Center for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel-Riems, Germany., Schlabe S; University Hospital Bonn, Department of Internal Medicine I, Bonn, Germany.; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany., Feldt T; University Hospital Düsseldorf, Department of Gastroenterology, Hepatology and Infectious Diseases, Düsseldorf, Germany., Gobbi F; Department of Infectious/Tropical diseases and Microbiology, IRCSS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy., Krieg A; Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf., Bode JG; University Hospital Düsseldorf, Department of Gastroenterology, Hepatology and Infectious Diseases, Düsseldorf, Germany., Fuchs A; Internal Medicine III-Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Germany., Kraef C; Centre of Excellence for Health, Immunity and Infections & Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark., Praktiknjo M; University Hospital Bonn, Department of Internal Medicine I, Bonn, Germany.; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany., Trebicka J; Department of Internal Medicine I, Goethe University Clinic Frankfurt, Germany., Ramharter M; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; German Center for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel-Riems, Germany., Addo MM; German Center for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel-Riems, Germany.; Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.; Department for Clinical Immunology of Infectious Diseases, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany., Strassburg C; University Hospital Bonn, Department of Internal Medicine I, Bonn, Germany.; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Germany., Lohse AW; German Center for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel-Riems, Germany.; Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany., Luedde T; University Hospital Düsseldorf, Department of Gastroenterology, Hepatology and Infectious Diseases, Düsseldorf, Germany., Schmiedel S; Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany., Orth HM; University Hospital Düsseldorf, Department of Gastroenterology, Hepatology and Infectious Diseases, Düsseldorf, Germany.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2021 Dec 21; Vol. 15 (12), pp. e0010065. Date of Electronic Publication: 2021 Dec 21 (Print Publication: 2021).
DOI: 10.1371/journal.pntd.0010065
Abstrakt: Background: Transjugular intrahepatic portosystemic shunt (TIPS) and shunt surgery are established treatment options for portal hypertension, but have not been systematically evaluated in patients with portal hypertension due to hepatosplenic schistosomiasis (HSS), one of the neglected tropical diseases with major impact on morbidity and mortality in endemic areas.
Methods: In this retrospective case study, patients with chronic portal hypertension due to schistosomiasis treated with those therapeutic approaches in four tertiary referral hospitals in Germany and Italy between 2012 and 2020 were included. We have summarized pre-interventional clinical data, indication, technical aspects of the interventions and clinical outcome.
Findings: Overall, 13 patients with confirmed HSS were included. 11 patients received TIPS for primary or secondary prophylaxis of variceal bleeding due to advanced portal hypertension and failure of conservative management. In two patients with contraindications for TIPS or technically unsuccessful TIPS procedure, proximal splenorenal shunt surgery in combination with splenectomy was conducted. During follow-up (mean follow-up 23 months, cumulative follow-up time 31 patient years) no bleeding events were documented. In five patients, moderate and transient episodes of overt hepatic encephalopathy were observed. In one patient each, liver failure, portal vein thrombosis and catheter associated sepsis occurred after TIPS insertion. All complications were well manageable and had favorable outcomes.
Conclusions: TIPS implantation and shunt surgery are safe and effective treatment options for patients with advanced HSS and sequelae of portal hypertension in experienced centers, but require careful patient selection.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Jonel Trebicka received speaking and consulting fees from W. L. Gore & Associates, Inc. Ansgar W. Lohse received consulting fees from Genfit SA and Roche Pharma. All other authors declare no conflict of interest.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje