Previous reports have suggested that 46%-70% of patients with refractory HE show large spontaneous portosystemic shunts (SPSSs) upon radiological screening.7–9 Therefore, the presence of a SPSS not only provides an explanation for the persistence or recurrence of HE despite an acceptable liver function, it might also represent a therapeutic target. Although this latter concept seems straightforward, an extensive literature search has resulted in only a few reports that have either occluded SPSSs surgically or radiologically by means of embolization.10-15 Selinexor ic50 Due to the anecdotal

nature of these reports (largest radiological series n = 11) and heterogeneous selection of patients between series, it is hardly possible to draw any firm conclusion with regard to overall efficacy.11-15 Moreover, concerns about potential aggravation of portal hypertension and procedure-related thrombosis have been stated but remain unopposed, which sustains the Selleck NVP-AUY922 high-risk label associated with this procedure.16, 17 Using this background and to overcome these shortcomings, we aimed to assess the efficacy and safety of embolization of large SPSSs for the treatment of chronic therapy-refractory

HE in a European multicentric working group and to identify patients that may benefit or not from this procedure. EASL-CLIF, European Association for the Study of the Liver – Consortium on Chronic Liver Insufficiency; HE, hepatic encephalopathy; MELD, Model of Endstage Liver Disease; mRS, modified Rankin Scale; SPSS, spontaneous portosystemic shunt; SRS, splenorenal shunt; TIPS, transjugular intrahepatic portosystemic Protein kinase N1 shunt. This project was a retrospective, multicenter cohort study of a group of

patients with cirrhosis and refractory chronic hepatic encephalopathy with large SPSSs amenable to angiographic embolization in six European liver units. Refractory chronic HE was defined as recurrent episodes of HE (≥grade 2 according to the West Haven classification) without clear identifiable precipitant and with at least two hospital admissions because of HE after the start of standard therapy or as persisting HE 30 days after the start of medical therapy and requiring continuous hospital admission.18, 19 Standard medical therapy consisted of maximally tolerated daily lactulose/lactitol with or without add-on of selective intestinal decontamination using neomycin or rifaximin, according to the discretion of the treating physician. SPSSs were identified by angio-computed tomography (CT) and/or magnetic resonance imaging (MRI) and included splenorenal shunt (SRS), recanalized (para) umbilical veins, portocaval, or mesorenal/caval shunts.