Hepatic Encephalopathy and Acute Variceal Bleeding

Hepatic Encephalopathy (HE) is a severe complication of cirrhosis. Gastrointestinal bleeding is a classic precipitating factor of HE. Hence, HE bouts should be treated if present at the onset of bleeding and prevented in other cases. The presence of HE is associated with an impaired prognosis in the case of variceal bleeding, with significantly higher mortality. In case of refractory bleeding, HE does not contra-indicate rescue TIPS. History of HE is not a contra-indication to preemptive TIPS. Recent data suggest that pre-emptive TIPS placement improves prognosis in high-risk patients presenting with HE. Hence, the presence of HE should not be a contra-indication to preemptive TIPS.