We describe a case of Inose-type hepatic encephalopathy due to congenital gastro-renal shunt that was effectively treated with balloon-occluded retrograde transvenous obliteration (B-RTO). An 80-year-old woman repeatedly experienced syncope. Her plasma concentration of NH₃ was elevated to 2363 level and syncope attacks improved after the gastro-renal shunt was closed by B-RTO. Although a congenital gastro-renal shunt is usually treated by surgical ligation, B-RTO is can be effective and less invasive treatment for such cases.

Enteral feeding is generally accepted in patients who cannot take nutrients orally. Percutaneous endoscopic gastrostomy (PEG) is a major enteral means for the introduction of nutritional solutions. However, jejunal feeding is sometimes employed instead of gastric feeding in cases of post-gastrectomy or repeated aspiration after PEG. The digestion and absorption of nutrients in trans-jejunal feeding might be different from those in trans-gastric feeding. In the present study, we measured the serum concentations of micronutrients and vitamins in the cases of direct percutaneous endoscopic jejunostomy (D-PEJ), compared to those of PEG. The enteral feeding has been continued for more than six months in all the cases. Serum copper and zinc concentration were significantly decreased in the D-PEJ group, whereas no significant difference in the concentrations of iron, selenium, vitamins A, B12 and E was ovserved between the two groups. Anemia and neutropenia were frequently observed in many patients with D-PEJ. These conditions were associated with copper deficiency. Much attention should be paid to copper and zinc deficiency in long-term trans-jejunal feeding.
Upper case dee ; Percutaneous endoscopic jejunostomy [PEJ] ; Percutaneous endoscopic gastrostomy ; Serum ; Feeding