Universität zu Köln

Nordmann, Tamara ORCID: 0000-0002-1936-8409, Schlabe, Stefan, Feldt, Torsten ORCID: 0000-0002-6755-4492, Gobbi, Federico, Krieg, Andreas ORCID: 0000-0003-2496-1079, Bode, Johannes G., Fuchs, Andre ORCID: 0000-0002-6906-2598, Kraef, Christian, Praktiknjo, Michael, Trebicka, Jonel ORCID: 0000-0002-7028-3881, Ramharter, Michael, Addo, Marylyn M., Strassburg, Christian, Lohse, Ansgar W., Luedde, Tom, Schmiedel, Stefan and Orth, Hans Martin ORCID: 0000-0003-3053-6730 (2021). TIPS and splenorenal shunt for complications of portal hypertension in chronic hepatosplenic schistosomiasis-A case series and review of the literature. Plos Neglect. Trop. Dis., 15 (12). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1935-2735

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Abstract

Author summaryHepatosplenic schistosomiasis is a severe form of chronic infection with various trematodes of the genus Schistosoma, characterized by portal venous fibrosis, splenomegaly with hypersplenism, and portal hypertension with subsequent life-threatening bleeding events. While effective anthelminthic treatment is available, portal fibrosis is only partially reversible. Portal hypertension with subsequent bleeding events as a complication is hitherto insufficiently addressed. Surgical techniques are currently the best established treatment option for HSS, despite their inherent complication risk and irreversibility. Interventional procedures like TIPS have rarely been assessed in HSS with mixed results. In a series of 13 cases with follow-up periods up to 99 months and a cumulative follow-up of 30.9 years, we demonstrate excellent bleeding prophylaxis and a low adverse event rate of TIPS and-if TIPS proves infeasible-splenorenal shunt surgery. Main complications of TIPS comprise transient hepatic encephalopathy and increase of liver enzymes, especially in patients with hepatic comorbidities. Due to necessary infrastructure and skills, TIPS implantation is currently limited to specialized centers. However, we think that our study can support the establishment and development of new treatment options for schistosomiasis and, in the medium term, also improve the prognosis of this neglected tropical disease in endemic regions. BackgroundTransjugular 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. MethodsIn 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. FindingsOverall, 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. ConclusionsTIPS 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Nordmann, Tamara UNSPECIFIED orcid.org/0000-0002-1936-8409 UNSPECIFIED Schlabe, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Feldt, Torsten UNSPECIFIED orcid.org/0000-0002-6755-4492 UNSPECIFIED Gobbi, Federico UNSPECIFIED UNSPECIFIED UNSPECIFIED Krieg, Andreas UNSPECIFIED orcid.org/0000-0003-2496-1079 UNSPECIFIED Bode, Johannes G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fuchs, Andre UNSPECIFIED orcid.org/0000-0002-6906-2598 UNSPECIFIED Kraef, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Praktiknjo, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Trebicka, Jonel UNSPECIFIED orcid.org/0000-0002-7028-3881 UNSPECIFIED Ramharter, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Addo, Marylyn M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Strassburg, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Lohse, Ansgar W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Luedde, Tom UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmiedel, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Orth, Hans Martin UNSPECIFIED orcid.org/0000-0003-3053-6730 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-601451
DOI:	10.1371/journal.pntd.0010065
Journal or Publication Title:	Plos Neglect. Trop. Dis.
Volume:	15
Number:	12
Date:	2021
Publisher:	PUBLIC LIBRARY SCIENCE
Place of Publication:	SAN FRANCISCO
ISSN:	1935-2735
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTRAHEPATIC PORTOSYSTEMIC SHUNT; MORBIDITY Multiple languages Infectious Diseases; Parasitology; Tropical Medicine Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/60145