A 52-year-old man from Pakistan who had suffered from liver cirrhosis and portal hypertension for two years consulted King’s College Hospital London in Dubai. The patient has also been diabetic for the last 15 years and the cause of his liver cirrhosis was fatty liver disease.
According to Dr Kaiser Raja, Consultant in Liver Diseases and Transplant Hepatology at King’s Dubai the patient’s concern was recurrent bleeding from congested veins (varices) in the stomach and food-pipe. “Actually, in the last year, he had had four episodes of massive and life-threatening bleeding,” explains Dr Kaiser, adding that each time he presented with vomiting large quantities of blood as well as the passage of blood in the stool. Each occurrence required ICU admission, endoscopy, and blood transfusion.
“However, repeated endoscopies were not able to control the bleeding because such bleeding episodes in patients with cirrhosis carry a 20-30% mortality rate,” he states noting that patient’s doctors back in Pakistan, recommended that he undergo urgent liver transplantation to prevent further episodes of bleeding.
While liver transplantation is a curative treatment for cirrhosis, it is a daunting procedure and has its own risks and complications. It requires a healthy family member of a compatible blood group and tissue match who can donate part of his/her liver to the patient. It also requires specialized medical facilities and is an expensive procedure. Lifelong medications are needed to prevent rejection of the transplanted liver. While 90 per cent of patients usually do well at one-year after a liver transplant, survival rates are about 60-70 per cent.
But before this patient could plan for his liver transplantation, he came across King’s College Hospital in Dubai and their specialisation in liver diseases, and that’s how he ended there.
To start off the process, he had an online consultation with Dr Kaiser who says that the patient’s results and scans were discussed with the liver transplantation team at King’s College Hospital in London. “While a liver transplant was a viable option for this patient, it was assessed that the patient’s main problem was recurrent bleeding from varices in the stomach and food-pipe due to portal hypertension. His liver was still functioning quite well.” The doctors at King’s College Hospital, therefore, recommended a special procedure called Trans-jugular Intrahepatic Portosystemic Shunt (TIPS).
What is TIPS?
The TIPS procedure involves the placement of a special wire mesh stent in the liver, which helps to reduce the resistance to blood flow through the liver and therefore reduces the portal hypertension and helps control bleeding from varices in the food-pipe and stomach.
Dr Parveen Peddu, Consultant Radiologist and Clinical Lead Interventional Hepatobiliary Radiology from King’s College Hospital in London performed this procedure at King’s College Hospital in Dubai. The patient was discharged within one day and was able to travel back to Pakistan after five days. He will be followed up regularly via telemedicine and coordination with his doctors in Pakistan.
The TIPPS procedure will hopefully be able to avoid a liver transplant in this patient for three to five years. As and when he develops other problems due to his liver disease or develops signs of liver failure, he will be considered for a liver transplant. For now, timely advice from experienced doctors at King’s College Hospital in Dubai have helped him avoid a liver transplant surgery.
What is liver cirrhosis?
Dr Kaiser explains liver cirrhosis as a condition that occurs as a result of long-term liver damage which leads to the formation of scars in the liver. “This is a life-threatening condition that eventually leads to liver failure and untimely death,” he explains, adding that the most common cause of liver cirrhosis now-a-days is fatty liver disease, which is extremely common in individuals who are obese or diabetic.
Who is at risk of liver cirrhosis?
From his own experience, Dr Kaiser notes that overall, about 1 in 10 diabetic or obese individuals are at risk of developing cirrhosis. Also, the condition also occurs in those who consume excess alcohol or in those who are infected with hepatitis B or C virus. However, he continues, early cirrhosis is often difficult to diagnose since it does not cause any symptoms and patients usually feel healthy.
“Typical symptoms of advanced cirrhosis include nausea, fatigue, loss of appetite, weight loss, yellowing of the eyes and skin (jaundice), itchy skin and dark urine.” States the doctor adding that as liver function deteriorates, there is an accumulation of excess fluid in the body that leads to swelling of the legs and belly (ascites).
“Cirrhosis is also related to portal hypertension, which leads to congestion of blood vessels in the food-pipe and stomach. These vessels, called varices can rupture and cause life threatening bleeding as seen in the case of the patient mentioned above,” he says noting that patients who have liver cirrhosis are also at a higher risk for developing liver cancer. “While medical treatment is possible for early liver cirrhosis, liver transplantation is the only curative option for advanced liver cirrhosis.”
