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/
Experimental hypertension was produced by intravenous infusion of norepinephrine in 13 conscious dogs. Electroacupuncture at the dogs' "Tsu San-Li" (St. 36) points showed a significant decrease in blood pressure, while the heart rate was not affected. The depressor effect was naloxone (0.2 mg/kg iv) reversible, and accompanied by an increased blood flow at the mesenteric artery, so it is suggested that the depressor effect was due to inhibition of the sympathetic vasoconstrictor tone. This inhibition was mediated by endogenous opioid peptides released by acupuncture. The location of this mediation was further analyzed. The central mechanism was evidenced by the ineffectiveness of acupuncture in reducing blood pressure in anesthetized dogs. On the other hand, the demonstration of opiate receptors in the blood vessels by radio-receptor assay provided evidence of peripheral mediation of blood pressure by opioids. The blood vessel might be a target organ for the plasma opioids, which can also be increased by acupuncture.
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