The clinical applicability of percutaneous splenic vein stent implantation for pancreatic portal hypertension

Abstract

Background Pancreatic portal hypertension (PPH) is a type of extrahepatic portal hypertension. We compared the clinical efficacy of different treatment methods for PPH caused by splenic vein stenosis in chronic pancreatitis. Methods This article retrospectively analyzed the PPH cases that were caused by splenic vein stenosis after chronic pancreatitis. Patients were divided into three groups according to the different treatments: splenic vein stent implantation (stent group), splenectomy, and only medications (conservative group). The treatment effects from each group were compared. Results A total of 33 patients were retrospectively analyzed in this study (9, 12, and 12 patients in each group respectively). All the procedures were successful in the stent and splenectomy groups. During the follow-up, no patient had gastrointestinal bleeding recurrence in the stent and splenectomy groups. However, in the conservative group, the incidence of portal hypertensive gastropathy and upper gastrointestinal bleeding were 50% and 25%. In the stent group, all the varicose veins at the base of the stomach had shrunk by varying degrees, and the red color signs regressed. The stent patency rate was 100%. No major complication occurred. The average platelet count at 1, 3, 6-months postoperatively were all significantly higher than the preoperative value (P < 0.05). The average postoperative hospital stay duration was significantly shorter than that of the splenectomy group (3.1 ± 1.4 days vs. 16.1 ± 8.1 days; P < 0.05). In the splenectomy group, postoperative fever occurred in 4 patients. Postoperative infection occurred in 2 patients (one with abdominal cavity infection and the other with incision infection). Delayed abdominal bleeding occurred in one patient. Portal vein thrombosis occurred in 2 patients during follow up. Conclusion Percutaneous splenic vein stent implantation for PPH treatment reduces the risk of gastrointestinal bleeding with minimal invasive. It has a high safety and reliable efficacy and is worthy of further clinical promotion.

Splenectomy versus non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis

“…Included studies contained 1 prospective study 22 and 17 retrospective studies. 16 , 23 – 38 Two studies were performed in the United States, 39 , 26 one study was from Spain, 23 one study was from Japan, 38 and the rest of the studies were from China. A total of 624 patients were included in this meta-analysis.…”

Combined transhepatic and transsplenic recanalization of chronic splenic vein occlusion to treat left-sided portal hypertension: A cases report

“…[3][4][5] Compared with traditional splenectomy, splenic venoplasty has no surgical complications such as bleeding and infection, and has a shorter hospital stay and relatively lower overall treatment costs. [6] And compared to partial splenic embolization, splenic venoplasty has significant advantages in preventing PSPH rebleeding. The bleeding rate of splenic venoplasty is only 7.1%, which is much lower than partial splenic embolization (rebleeding rate is 47.8%).…”

Percutaneous transhepatic sclerotherapy for ascending colonic varices due to left-sided portal hypertension

“…Splenectomy is more invasive than interventional radiology, and results in a longer postoperative hospital stay. Additionally, there are several postoperative complications, including bleeding and infection [11] .…”