An emergency hybrid procedure that combines endoscopic treatment with partial splenic embolization for bleeding esophagogastric varices

Chikamori, Fumio; Maeda, Atsuki; Sharma, Niranjan

doi:10.1016/j.radcr.2022.02.041

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…The bleeding clearly stopped after the procedure [ 38 ]. Chikamori et al describe in another case report an emergency hybrid procedure that combines endoscopic treatment with PSE for bleeding esophagogastric varices in two patients (1 patient with CPH and 1 patient with NCPH) [ 50 ]. In a case report published in 2010, Saugel et al report successful PSE in a patient with bleeding gastric varices and splenic vein thrombosis in NCPH [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Partial splenic embolization as a rescue and emergency treatment for portal hypertension and gastroesophageal variceal hemorrhage

et al. 2023

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Background Partial splenic embolization (PSE) is a non-surgical procedure which was initially used to treat hypersplenism. Furthermore, partial splenic embolization can be used for the treatment of different conditions, including gastroesophageal variceal hemorrhage. Here, we evaluated the safety and efficacy of emergency and non-emergency PSE in patients with gastroesophageal variceal hemorrhage and recurrent portal hypertensive gastropathy bleeding due to cirrhotic (CPH) and non-cirrhotic portal hypertension (NCPH). Methods From December 2014 to July 2022, twenty-five patients with persistent esophageal variceal hemorrhage (EVH) and gastric variceal hemorrhage (GVH), recurrent EVH and GVH, controlled EVH with a high risk of recurrent bleeding, controlled GVH with a high risk of rebleeding, and portal hypertensive gastropathy due to CPH and NCPH underwent emergency and non-emergency PSE. PSE for treatment of persistent EVH and GVH was defined as emergency PSE. In all patients pharmacological and endoscopic treatment alone had not been sufficient to control variceal bleeding, and the placement of a transjugular intrahepatic portosystemic shunt (TIPS) was contraindicated, not reasonable due to portal hemodynamics, or TIPS failure with recurrent esophageal bleeding had occurred. The patients were followed-up for six months. Results All twenty-five patients, 12 with CPH and 13 with NCPH were successfully treated with PSE. In 13 out of 25 (52%) patients, PSE was performed under emergency conditions due to persistent EVH and GVH, clearly stopping the bleeding. Follow-up gastroscopy showed a significant regression of esophageal and gastric varices, classified as grade II or lower according to Paquet’s classification after PSE in comparison to grade III to IV before PSE. During the follow-up period, no variceal re-bleeding occurred, neither in patients who were treated under emergency conditions nor in patients with non-emergency PSE. Furthermore, platelet count increased starting from day one after PSE, and after one week, thrombocyte levels had improved significantly. After six months, there was a sustained increase in the thrombocyte count at significantly higher levels. Fever, abdominal pain, and an increase in leucocyte count were transient side effects of the procedure. Severe complications were not observed. Conclusion This is the first study analyzing the efficacy of emergency and non-emergency PSE for the treatment of gastroesophageal hemorrhage and recurrent portal hypertensive gastropathy bleeding in patients with CPH and NCPH. We show that PSE is a successful rescue therapy for patients in whom pharmacological and endoscopic treatment options fail and the placement of a TIPS is contraindicated. In critically ill CPH and NCPH patients with fulminant gastroesophageal variceal bleeding, PSE showed good results and is therefore an effective tool for the rescue and emergency management of gastroesophageal hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Partial splenic embolization as a rescue and emergency treatment for portal hypertension and gastroesophageal variceal hemorrhage

et al. 2023

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“…PSE not only increases platelet count but also reduces the portal venous pressure, splenic venous blood flow volume and spleen/liver volume ratio [4] , [5] , [6] . We have reported the advantages of the hybrid procedure combining endoscopic treatment and PSE for esophagogastric varices [8] . However, in this case, splenomegaly was not evident and it seemed difficult to expect the portal decompression effect only by PSE.…”

Section: Discussionmentioning

confidence: 99%

“…Because portal venous pressure is associated with bleeding, it is important to reduce portal venous pressure to prevent rebleeding [7] . We have reported an emergency hybrid procedure that combines endoscopic treatment with PSE for bleeding esophagogastric varices [8] . However, in the cases of esophagogastric varices without splenomegaly, dilatation of the left gastric arteriovenous shunt is considered the cause of varices formation [9 , 10] .…”

Section: Introductionmentioning

confidence: 99%

Verification of thrombus formation just after endoscopic injection sclerotherapy with ligation for esophagogastric varices by venous phase of left gastric arteriography

Chikamori

Kanazawa

Sharma³

2022

Radiology Case Reports

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“…Because portal venous pressure is associated with bleeding, it is important to control portal venous pressure to prevent variceal bleeding [3] , [4] , [5] . We have reported a hybrid procedure that combines endoscopic treatment with partial splenic artery embolization (PSE) for esophagogastric varices [6] . However, in the cases of severe esophagogastric varices with gastrorenal shunt and splenomegaly, optimal therapeutic strategies have not yet been established.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous transhepatic obliteration for life-threatening bleeding after endoscopic variceal ligation in a patient with severe esophagogastric varices

An emergency hybrid procedure that combines endoscopic treatment with partial splenic embolization for bleeding esophagogastric varices

Cited by 6 publications

References 22 publications

Partial splenic embolization as a rescue and emergency treatment for portal hypertension and gastroesophageal variceal hemorrhage

Partial splenic embolization as a rescue and emergency treatment for portal hypertension and gastroesophageal variceal hemorrhage

Verification of thrombus formation just after endoscopic injection sclerotherapy with ligation for esophagogastric varices by venous phase of left gastric arteriography

Percutaneous transhepatic obliteration for life-threatening bleeding after endoscopic variceal ligation in a patient with severe esophagogastric varices

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