Trashepatic left gastric vein embolization in the treatment of recurrent hemorrhaging in patients with schistosomiasis previously submitted to non-derivative surgery

Abstract

-Context -Non-derivative surgical techniques are the treatment of choice for the control of upper digestive tract hemorrhages after schistosomotic portal hypertension. However, recurrent hemorrhaging due to gastroesophagic varices is frequent. Objective -To evaluate the outcome of treatment based on embolization of the left gastric vein to control the reoccurrence of hemorrhages caused by gastroesophagic varices in patients with schistosomiasis previously submitted to non-derivative surgery. Methods -Rates of reoccurrence of hemorrhages and the qualitative and quantitative reduction of gastroesophagic varices in patients undergoing transhepatic embolization of the left gastric vein between December 1999 and January 2009 were studied based on medical charts and follow-up reports. Results -Seven patients with a mean age of 39.3 years underwent percutaneous transhepatic embolization of the left gastric vein. The mean time between azigoportal disconnections employed in combination with splenectomy and the percutaneous approach was 8.4 ± 7.3 years, and the number of episodes of digestive hemorrhaging ranged from 1 to 7 years. No episodes of reoccurrence of hemorrhaging were found during a follow-up period which ranged from 6 months to 7 years. Endoscopic postembolization studies revealed reductions in gastroesophagic varices in all patients compared to preembolization endoscopy. Conclusions -Percutaneous transhepatic embolization of the left gastric vein in patients with schistosomiasis previously submitted to surgery resulted in a decrease in gastroesophagic varices and was shown to be effective in controlling hemorrhage reoccurrence.

Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature

“…Huang and colleagues [55] reported that the rate of first UGB episodes at 3 and 5 years was significantly lower, compared to no intervention, when preventive pericardial disconnection was applied on patients who had never bled before, but no numerical data were provided in the abstract. Saad and colleagues [56] found no rebleeding episodes, within 1.5 years from intervention, when gastric vein embolization was performed in patients treated with EGDS and variceal sclerotherapy but still unsatisfactory bleeding control.…”

“…Two included papers described interventions on veins feeding gastroesophageal varices (gastric, azygos) [55,56]. Although it is not possible to attempt any comparison of outcomes between these interventions and local variceal management techniques, the rate of rebleeding after portal-azygous disconnection was within the range of that reported in publications on local variceal management.…”

“…SS, statistically significant, NS, not statistically significant, NR, statistical analysis not reported. #n = intervention indicated in the corresponding "Intervention #n" column of the table to which the outcome direction refers[42,52,53,[55][56][57][58][59][60][61][62][63][64][65][66].https://doi.org/10.1371/journal.pntd.0009191.g004…”