Application of fecal microbial transplantation in hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Rationale: Transjugular intrahepatic portosystemic shunt (TIPS) is mainly used to treat acute and chronic esophageal, gastric, and intestinal variceal bleeding and refractory ascites caused by portal hypertension. The most common complication of TIPS is the development of hepatic encephalopathy (HE). Fecal microbiota transplantation (FMT) is an emerging method for treating diseases by altering the intestinal flora. We present 2 cases of FMT that ameliorated liver function and HE after TIPS. Patient concerns: In this report, 2 patients with liver cirrhosis secondary to hepatitis B had recurrent Grade 2-3 HE after TIPS. Diagnosis: Two patients were diagnosed as having HE. Interventions: The 2 patients separately received 3 times of FMT. Outcomes: The liver function of both patients improved, the clinical symptoms were relieved, and the number of HE attacks decreased significantly after FMT. Lessons: FMT may be another effective way to treat HE, and is worthy of further research.