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

Abstract

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/

Spleen volume-based non-invasive tool for predicting hepatic decompensation in people with compensated cirrhosis (CHESS1701)

“…The use of these factors can improve decompensation risk apart from structural alterations. 13 , 29 , 30 Combining the above 2 points, the spleen-based model outperformed the traditional serum-based models. Aetiology was initially sieved out during model building, implying it was less important, 27 and the model could be applied to different aetiologies.…”

Progress in Endoscopic and Interventional Treatment of Esophagogastric Variceal Bleeding

“…Compared with PSE, SATE also has the advantages of simple technique, can quickly reduce portal pressure, and has a significant effect on EVB control and prevention, and its complications are mild and easy to tolerate. It can be safely used in Child grade C patients [26,[51][52][53][54]. Although there is no clinical report of combining it with endoscopic therapy for EVB control and prevention, the combined therapy of splenic artery embolization and endoscopic therapy is theoretically capable of rapidly reducing portal pressure.…”

Minimally invasive treatment of cirrhotic secondary hypersplenism with high-intensity focused ultrasound

“…Zunyi Medical University, Zunyi, China. 2 The High Intensity Focused Ultrasound Center, Suining Central Hospital, Suining, Sichuan, China. 3 The Department of Radiology, Suining Central Hospital, Suining, Sichuan, China.…”

“…In clinical practice, second hypersplenism caused by cirrhosis is very common. From invasive methods (splenectomy) to minimally invasive methods (partial splenic embolization/radiofrequency ablation), doctors and investigators try their best to address cirrhotic hypersplenism with the least harm to patients with the hope of obtaining the most benefits [1][2][3] . However, since secondary hypersplenism often occurs in patients with decompensated cirrhosis, the patients' poor condition combined with hyperkinesis of the portal vein and fragile spleen tissues make not only the recovery of the patient long and difficult but also the incidence of complications high.…”