PDF(Pubmed)
Abstract：
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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：部分脾栓塞术（PSE）是一种非手术过程，最初用于治疗脾功能亢进。此外，部分脾栓塞术可用于不同情况的治疗，包括胃食管静脉曲张出血。这里,我们评估了急诊和非急诊PSE对肝硬化(CPH)和非肝硬化门脉高压(NCPH)引起的胃食管静脉曲张破裂出血和复发性门脉高压性胃病出血患者的安全性和有效性.
方法：2014年12月至2022年7月，25例持续性食管静脉曲张破裂出血（EVH）和胃静脉曲张破裂出血（GVH）患者，复发性EVH和GVH，控制性EVH具有高复发性出血风险，控制的GVH有很高的再出血风险，由于CPH和NCPH引起的门脉高压性胃病接受了紧急和非紧急PSE。用于治疗持续性EVH和GVH的PSE定义为急诊PSE。在所有患者中，单独的药物和内镜治疗不足以控制静脉曲张出血，经颈静脉肝内门体分流术（TIPS）的放置是禁忌的，由于门静脉血流动力学不合理，或发生TIPS失败并复发食管出血。随访6个月。
结果：所有25名患者，用PSE成功地处理了12例CPH和13例NCPH。在25名患者中的13名(52%)，由于持续EVH和GVH，在紧急情况下进行了PSE。明显止血.后续胃镜检查显示食管和胃静脉曲张明显消退，根据PSE后的Paquet分类，与PSE前的III至IV级相比，分类为II级或更低。在后续期间,没有发生静脉曲张再出血,在急诊条件下接受治疗的患者和非急诊PSE患者均未接受治疗。此外，从PSE后第一天开始血小板计数增加，一周后，血小板水平显著改善.六个月后,血小板计数在显著较高水平时持续增加.发烧,腹痛,白细胞计数的增加是该程序的一过性副作用。未观察到严重并发症。
结论：这是首次分析急诊和非急诊PSE治疗CPH和NCPH患者胃食管出血和复发性门脉高压性胃病出血的疗效。我们表明，对于药物和内窥镜治疗方案失败且禁忌放置TIPS的患者，PSE是一种成功的抢救疗法。在患有暴发性胃食管静脉曲张破裂出血的危重CPH和NCPH患者中，PSE显示出良好的效果，因此是胃食管出血的抢救和急诊处理的有效工具。
方法：2014年12月至2022年7月，25例持续性食管静脉曲张破裂出血（EVH）和胃静脉曲张破裂出血（GVH）患者，复发性EVH和GVH，控制性EVH具有高复发性出血风险，控制的GVH有很高的再出血风险，由于CPH和NCPH引起的门脉高压性胃病接受了紧急和非紧急PSE。用于治疗持续性EVH和GVH的PSE定义为急诊PSE。在所有患者中，单独的药物和内镜治疗不足以控制静脉曲张出血，经颈静脉肝内门体分流术（TIPS）的放置是禁忌的，由于门静脉血流动力学不合理，或发生TIPS失败并复发食管出血。随访6个月。
结果：所有25名患者，用PSE成功地处理了12例CPH和13例NCPH。在25名患者中的13名(52%)，由于持续EVH和GVH，在紧急情况下进行了PSE。明显止血.后续胃镜检查显示食管和胃静脉曲张明显消退，根据PSE后的Paquet分类，与PSE前的III至IV级相比，分类为II级或更低。在后续期间,没有发生静脉曲张再出血,在急诊条件下接受治疗的患者和非急诊PSE患者均未接受治疗。此外，从PSE后第一天开始血小板计数增加，一周后，血小板水平显著改善.六个月后,血小板计数在显著较高水平时持续增加.发烧,腹痛,白细胞计数的增加是该程序的一过性副作用。未观察到严重并发症。
结论：这是首次分析急诊和非急诊PSE治疗CPH和NCPH患者胃食管出血和复发性门脉高压性胃病出血的疗效。我们表明，对于药物和内窥镜治疗方案失败且禁忌放置TIPS的患者，PSE是一种成功的抢救疗法。在患有暴发性胃食管静脉曲张破裂出血的危重CPH和NCPH患者中，PSE显示出良好的效果，因此是胃食管出血的抢救和急诊处理的有效工具。
