Non-variceal Extrahepatic Portosystemic Shunts: A Review of Pathogenesis, Diagnosis, and Treatment (IMAGE)
Caption
Acquired SEPS are associated with portal hypertension, cirrhosis, and complications of decompensation. In particular, the effects of NVEPS on portal pressure are variable, but there is evidence of mitigation of portal hypertension and consequent gastro-esophageal varices. The risk of PVT may be increased due to decreased portal flow. HE may be a difficult management problem. The finding of end-stage cirrhosis with poorly responsive HE in the absence of esophageal or gastric varices, umbilical or hemorrhoidal venous dilatation, may be clues to the presence of NVEPS. The portal steal phenomenon, which leads to poor liver nutritional metabolism and toxic clearance, deterioration of liver function, and small liver volume, ultimately leads to higher mortality rates than those without NVEPS. Percutaneous endovascular therapy and TIPS have been widely investigated and implemented to mitigate complications and prevent further progression of cirrhosis. Accurate diagnosis, management, surveillance strategy, and timely intervention of NVEPS are paramount for potential improvement in survival outcomes. However, due to the complex and dynamic nature of liver function, the influence of both variceal SEPS and NVEPS, and other individual patient characteristics, management decisions need to be made on a case-by-case basis.
Credit
Nicole M. Anastasio, George Y. Wu
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License
CC BY-NC