Q: How long does it take for hepatic encephalopathy to manifest after Transjugular intrahepatic portosystemic shunt (TIPS)?


Answer: Contrary to popular belief, it takes about two to three weeks for hepatic encephelopathy to fully sits in after TIPS procedure in cirrhotic patients.1 Unfortunately, no prophylaxis (lactulose, rifaximin etc.) prevents it.2 Once encephalopathy sits in after TIPS, all offending causes should be eliminated along with standard of care treatment for hepatic encephalopathy.


Reference:

1. Riggio O, Merlli M, Pedretti G, et al. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Incidence and risk factors. Dig Dis Sci 1996; 41:578.

2. Riggio O, Masini A, Efrati C, et al. Pharmacological prophylaxis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: a randomized controlled study. J Hepatol 2005; 42:674.