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Hepatic encephalopathy verified by psychometric testing and EEG in cirrhotic patients: Effects of mesocaval interposition shunt or sclerotherapy
Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Pharmacology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pharmacology.
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2005 (English)In: HPB, ISSN 1365-182X, Vol. 7, no 1, 65-72 p.Article in journal (Refereed) Published
Abstract [en]

Background. The aim of this randomised prospective study was to evaluate hepatic encephalopathy after mesocaval interposition shunt operation and after repeated endoscopic sclerotherapy. Methods. Forty-five patients with bleeding oesophageal varices due to liver cirrhosis were randomised to the two treatment groups, 24 to the shunt group and 21 to the sclerotherapy group. The patients were evaluated preoperatively regarding blood tests, hepatic encephalopathy as measured by electroencephalogram with spectral analysis and by a battery of psychometric tests. The direction of portal flow in the shunt group was investigated by shunt phlebography and ultrasonography with Doppler. During follow-up the same investigations were performed twice at median 6.7 and 14.7 months after operation. Results. No statistically significant difference was found during follow-up regarding blood tests and electroencephalography with spectral analysis. Although the preoperative psychometric tests showed that the shunt group performed significantly better than the sclerotherapy group, the first follow-up showed that the shunt group performed statistically worse than the sclerotherapy group in seven of the tests: Synonyms (measuring verbal ability), Block Design Test (measuring visuo-spatial ability), Memory for Design Test, Error Score (measuring memory function), Revised Visual Retention Test, correct answers and the same test error answers (measuring visuo-spatial memory, ability and immediate memory), Digit Symbol Test (measuring perceptual ability) and Trial Making Test B (measuring cognitive motor abilities). Conclusions. Patients treated by mesocaval interposition shunt showed a progressive general reduction in psychometric performance compared with patients treated with repeated sclerotherapy, in whom a general intellectual improvement was observed. This finding corresponds to the reverse direction of the preoperative portal flow to a hepatofugal pattern at first follow-up and at 12 months among two-thirds of the patients. © 2005 Taylor & Francis Group Ltd.

Place, publisher, year, edition, pages
2005. Vol. 7, no 1, 65-72 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-30228DOI: 10.1080/13651820410030853Local ID: 15732OAI: diva2:251050
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2011-01-12

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Thorell, Lars-HåkanBengtsson, Finn
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Faculty of Health SciencesPsychiatryDepartment of PsychiatryClinical PharmacologyDepartment of Clinical Pharmacology
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