Acad Radiol. 2025 Oct 28:S1076-6332(25)00955-9. doi: 10.1016/j.acra.2025.09.049. Online ahead of print.
ABSTRACT
BACKGROUND & AIMS: Spontaneous portosystemic shunt (SPSS) embolization represents a promising intervention for refractory hepatic encephalopathy (HE). This systematic review and meta-analysis evaluate the efficacy and safety of SPSS embolization in cirrhotic patients without transjugular intrahepatic portosystemic shunts (TIPS).
METHODS: We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library through June 12, 2024 to identify studies investigating SPSS embolization for HE. Meta-analysis was performed using fixed-effect or random-effects models to calculate clinical success (defined as HE remission), procedural success rates, and complication frequencies.
RESULTS: Analysis of 10 retrospective studies encompassing 289 cirrhotic patients yielded the following pooled outcomes: hepatic encephalopathy remission rate of 83.1% (95% CI: 70.4%-93.1%), procedural success rate of 99.8% (95% CI: 98.3%-100%), and long-term adverse event rate of 42.9% (95% CI: 34.7%-51.4%). The predominant long-term complications included ascites (51.6% of complications), variceal progression (23.4%), and thrombosis (8.0%), while primary procedure-related adverse reactions were infection (37%) and fever (29%). Subgroup analyses demonstrated no statistically significant effect of etiology (p=0.788) or shunt type (p=0.271) on disease remission rates, but revealed significant differences between surgical approaches (p<0.001), with balloon-occluded retrograde transvenous obliteration (BRTO) showing the highest efficacy (97.4%-100%).
CONCLUSION: SPSS embolization demonstrates both high efficacy for refractory hepatic encephalopathy (83.1% remission rate) and exceptional procedural success (99.8%). Despite substantial long-term complications (42.9%, predominantly portal hypertension sequelae), current evidence from predominantly retrospective studies supports its consideration as a therapeutic option. Technique selection should be individualized pending further validation of BRTO’s superiority.
PMID:41162300 | DOI:10.1016/j.acra.2025.09.049
