Analysis of hepatic encephalopathy after distal splenorenal shunt--PTP image and pancreatic hormone kinetics.

The Warren-Zeppa selective distal spleno-renal shunt is aimed at decompressing esophageal varices while at the same time ligating left gastric, gastroepiploic and umbilical veins. But in the long term follow-up loss of shunt selectivity was observed in a number of cases (7/76), with hepatic encephalopathy resulting in 9.3%. In this study, we carried out percutaneous transhepatic portography and investigated pancreatic hormone kinetics in portal blood after arginine load, mainly in cases of hepatic encephalopathy after distal splenorenal shunt compared with non-encephalopathy cases of LC + Varix. These data suggested that as a cause of encephalopathy after distal splenorenal shunt, (1) a marked decrease in portal blood flow due to portal systemic shunt via the pancreatic vein was considered from PTP image, (2) a marked decrease in I/G ratio was considered from pancreatic hormone kinetics in portal blood.