Comparison of TIPS alone and combined with partial splenic embolization (PSE) for the management of variceal bleeding

Wan, Yue-Meng; Li, Yuhua; Wu, Hua‐Mei; Wu, Xinan; Xu, Ying

doi:10.1007/s00330-019-06046-6

Cited by 12 publications

(7 citation statements)

References 25 publications

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“…In a series of clinical trials, PSE alone or in combination with conventional therapies was reported to be beneficial in reducing the risk of variceal bleeding and variceal recurrence in cirrhosis patients [18][19][20]. However, no research has been conducted on the secondary prophylaxis management of gastroesophageal variceal hemorrhage in cirrhosis patients with hypersplenism.…”

Section: Discussionmentioning

confidence: 99%

Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial

et al. 2021

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Background Global research on endoscopic therapies in combination with partial splenic embolization (PSE) for variceal hemorrhage (VH) is limited. Therefore, we aimed to evaluate the efficacy and safety of endoscopy plus PSE (EP) treatment in comparison to endoscopic (E) treatment for the secondary prophylaxis of VH in cirrhosis patients with hypersplenism. Methods Cirrhosis patients with hypersplenism (platelet count < 100, 000/µL) and those who had recovered from an episode of VH were enrolled in a multicenter randomized controlled trial. The participants were randomly assigned into EP and E groups in a 1:1 ratio. The primary endpoint was variceal rebleeding, and the secondary endpoints were severe variceal recurrence and mortality during the 2-year follow-up. Hematological indices, serum biochemical parameters, and the Child–Pugh score were measured at each time point. Results From June 2016 to December 2019, 108 patients were enrolled in the study, among which 102 patients completed the protocol (51 in EP and 51 in E group). The rebleeding rate of the varices was significantly reduced in the EP group compared to that in the E group during the 2 years (16% vs. 31%, p < 0.001). The EP group showed a significantly lower variceal recurrence rate than the E group (22% vs. 67%, p < 0.001). The COX proportional hazard models revealed that grouping was an independent predictor for variceal rebleeding (H = 0.122, 95% CI 0.055–0.270, p < 0.001) and variceal recurrence (hazard ratio, H = 0.160, 95% CI 0.077–0.332, p < 0.001). The peripheral blood cell count, Child–Pugh class/score, albumin concentration, and coagulation function in the EP group improved significantly compared to the values observed in the E group at any time point (p < 0.05). Conclusions The EP treatment was more effective in preventing variceal rebleeding and variceal recurrence than the conventional E treatment during the secondary prophylaxis of VH in cirrhosis patients with hypersplenism. Furthermore, the EP treatment could significantly increase the peripheral blood cell count and albumin concentration and also improved the coagulation function and the Child–Pugh score. Clinical trials registration Trial registration number ClincialTrials.gov: NCT02778425. The URL of the clinical trial: https://clinicaltrials.gov/

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Section: Discussionmentioning

confidence: 99%

Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial

et al. 2021

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“…Wan YM et al found that the followed PSE after TIPS may improve the long-term primary shunt patency rate and markedly reduce the shunt dysfunction rates. But the overall survival was not significantly different between TIPS group and combined use of TIPS and PSE (TIPS + PSE) group [58]. Li YH et al also found that TIPS + PSE is superior to TIPS alone in controlling variceal rebleeding and shunt stenosis [59].…”

Section: Discussionmentioning

confidence: 97%

Efficacy and safety of laparoscopic splenectomy for hypersplenism secondary to portal hypertension after transjugular intrahepatic portosystemic shunt

Liu

2021

BMC Gastroenterol

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Background Laparoscopic splenectomy (LS) being used after Transjugular intrahepatic portosystemic shunt (TIPS) has not been reported. This report aims to explore the feasibility, safety, and potential efficacy of LS after TIPS hypersplenism secondary to portal hypertension (PHT). Methods We retrospectively reviewed a series of six patients who underwent LS after TIPS for hypersplenism secondary to PHT between 2014 and 2020. The perioperative data and patients’ clinical outcomes were recorded. Results LS was successfully performed in all patients. Hypersplenism was corrected after LS in all six patients. Postoperative prothrombin time, prothrombin activity, international normalized ratio, and total bilirubin showed a trend toward improvement. The preoperative and 1-month postoperative albumin and activated partial thromboplastin levels showed no significant difference. Plasma ammonia level and thromboelastography indicators were ameliorated in two limited recorded patients. No postoperative complications such as subphrenic abscess, portal vein thrombosis, variceal bleeding, hepatic encephalopathy, and liver failure occurred during the 1-month follow-up period. Conclusion LS following TIPS is feasible, safe, and beneficial for patients with hypersplenism secondary to PHT. The following LS not only corrects the hypersplenism, but also has the potential to improve liver function.

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“…While it can reduce the splenic flow and portosystemic gradient, current studies did not report a survival benefit with combined TIPS and splenic embolisation. 63 , 71 , 72 …”

Section: Transjugular Intrahepatic Portosystemic Shuntmentioning

confidence: 99%

Imaging-guided interventions modulating portal venous flow: Evidence and controversies

et al. 2022

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Comparison of TIPS alone and combined with partial splenic embolization (PSE) for the management of variceal bleeding

Cited by 12 publications

References 25 publications

Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial

Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial

Efficacy and safety of laparoscopic splenectomy for hypersplenism secondary to portal hypertension after transjugular intrahepatic portosystemic shunt

Imaging-guided interventions modulating portal venous flow: Evidence and controversies

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