Efficacy of percutaneous transhepatic variceal embolization with 2-Octyl-cyanoacrylate in patients with severe recurrent hepatic encephalopathy

ObjectiveTo investigate the efficacy and safety of percutaneous transhepatic variceal embolization (PTVE) performed with 2-Octyl-cyanoacrylate (2-OCA) tissue adhesive for treating recurrent hepatic encephalopathy (HE) involving large portosystemic shunts. MethodsTwelve cirrhotic patients (8 males, 4 females; mean age: 62 years old) with recurrent HE (≥3 episodes/year, despite drug therapy) were treated by PTVE with 2-OCA. The surgery was performed under local anesthesia with B ultrasound- or X-ray-guided percutaneous needle injection of the adhesive into the hepatic portal vein with balloon dilation to occlude the portosystemic shunts. Preoperative and postoperative clinical and laboratory parameters, including HE episodes, with or without gastrointestinal bleeding, markers of liver and renal function and coagulation indicators, were recorded. Significance of surgery-induced change in portal vein pressure was assessed by paired t-test. ResultsThe PTVE was performed successfully in all 12 patients. The average injected volume of 2-OCA was 8.6 ml (range: 4-16 ml). The most frequent postoperative complications were pyrexia (6/12, 50.0%) and abdominal pain (5/12, 41.7%). The mean follow-up period was 22.7±9.8 months (range: 6-37 months). During the follow-up period, two patients (16.7%) developed transient ascites and two (16.7%) patients developed upper gastrointestinal bleeding (due to esophageal varices and portal hypertensive gastropathy, respectively). In addition, three patients (25.0%) experienced HE recurrence (at postoperative months 16, 19, and 30, respectively). Two patients (16.7%) died, one from progression of hepatic failure and the other from liver cancer. In general, the PTVE procedure significantly increased the portal pressure (preoperative: (21.9±1.8) mm Hg vs. postoperative: (26.3±3.2) mm Hg; P=000). ConclusionPTVE with 2-OCA is an effective and safe procedure for managing recurrent HE with large portosystemic shunts.