Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation

Abstract

IntroductionUpper gastrointestinal bleeding (UGIB) is a severe and life-threatening complication among patients with portal hypertension (PH). Covered transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice for patients with refractory or recurrent UGIB despite pharmacological and endoscopic therapy. In some patients, TIPS implantation is not possible due to co-morbidity or vascular disorders. Spleen embolization (SE) may be a promising alternative in this setting.Materials and methodsWe retrospectively analyzed 9 patients with PH-induced UGIB who underwent partial SE between 2012 and 2016. All patients met the following criteria: (i) upper gastrointestinal hemorrhage with primary or secondary failure of endoscopic interventions and (ii) TIPS implantation not possible. Each patient was followed for at least 6 months after embolization.ResultsFive patients (56%) suffered from cirrhotic PH, 4 patients (44%) from non-cirrhotic PH. UGIB occured in terms of refractory hemorrhage from gastric varices (3/9; 33%), hemorrhage from esophageal varices (3/9; 33%), and finally, hemorrhage from portal-hypertensive gastropathy (3/9; 33%). None of the patients treated with partial SE experienced re-bleeding episodes or required blood transfusions during a total follow-up time of 159 months, including both patients with cirrhotic- and non-cirrhotic PH.DiscussionPartial SE, as a minimally invasive intervention with low procedure-associated complications, may be a valuable alternative for patients with recurrent PH-induced UGIB refractory to standard therapy.

Proximal Splenic Artery Embolization to Treat Refractory Ascites in a Patient With Cirrhosis

“…Fabrizio Di Benedetto, 7 Pietro Torricelli, 1 Erica Villa , 2 and Filippo Schepis 2 S ince the early 1970s several studies have reported distal splenic artery embolization, better known as partial spleen embolization (PSE), as an efficacious treatment of portal hypertensive variceal bleeding and hypersplenism in cirrhosis. (1,2) However, the effect of PSE on portal pressure is secondary to the induction of splenic infarction. Depending on both the infarct volume and possible infection, PSE can induce serious complications including death.…”

“…Cristian Caporali, 1 * Laura Turco, 2 * Francesco Prampolini, 1 Pietro Quaretti, 3 Marcello Bianchini, 2 Dario Saltini, 2 Francesca Miceli, 2 Federico Casari, 1 Davide Felaco, 1 Juan Carlos Garcia-Pagan , 4 Jonel Trebicka , 5 Marco Senzolo, 6 Gian Piero Guerrini, 7…”

Progress in Endoscopic and Interventional Treatment of Esophagogastric Variceal Bleeding

“…PSE combined with endoscopic techniques in the treatment of EVB can effectively control acute bleeding and prevent the occurrence of rebleeding [31]. It can also bring good clinical results in patients who cannot implement TIPS [50]. Taniai et al [23] studied the recurrence rate of GOV at 6 months, 1 year, and 2 years after surgery in patients who received EVL and PSE combined therapy and patients who were treated with EVL alone or EIS alone, and the results showed that the recurrence rate was significantly higher in the combination therapy group than that in the EVL or EIS alone treatment group [24].…”

Partial embolization of splenic lienal artery as related to patients with portal hypertension: current state of the issue (literature review)

“…M. Buechter с соавт. (2017) проанализировали результаты лечения 9 пациентов с портальной гипертензией, у которых имело место гастроэзофагальное кровотечение [17]. У 5 больных была портальная гипертензия на фоне цирроза печени, у 4 -нецирротическая портальная гипертензия.…”