Different Treatment For Cirrhosis Patients With Esophageal And Gastric Varices And Splenomegaly Or Hypersplenism

Objective:To investigate the efficacy of the combination of endoscopic treatment and partial splenic embolization(PSE)compared with endoscopic treatment alone in cirrhosis patients with esophageal and gastric variceal bleeding and splenomegaly or hypersplenism.Methods:A total of 29 patients with esophageal and gastric variceal bleeding and splenomegaly or hypersplenism were involved in this study.14 patients,8 males and 6 females,underwent endoscopic treatment(mean age 54.57±14.70 years,group A).15 patients,11 males and 4 females,underwent endoscopic treatment plus PSE(mean age 53.13±9.46 years,group B).After the first endoscopic treatment,patients in group A underwent endoscopic treatment two to four weeks later until varices eradicated or patients wanted to stop treatments.Patients in group B underwent PSE which was done one to four weeks before or after the endoscopic treatment and endoscopic treatment which is exactly the same as group A.The end point was rebleeding or six months after all treatments.Then those tests,including blood routine tests,blood coagulation parameters,liver function,renal function,abdominal ultrasonography or CT,Child-Pugh class and Karnofsky performance status score were performed and evaluated at one and six months after the last treatment.Analyze the relationship between rebleeding and possible risk factors.Results:During the following period,in group A,one patient with alcoholic cirrhosis and one with cryptogenic cirrhosis bled at the third and the sixth month,respectively.In group B,one patient with hepatitis B cirrhosis and one with alcoholic cirrhosis bled at the second and the fifth month,respectively.Without significant differences in rebleeding rate after all treatments in the two groups,the endoscopic variceal ligation(EVL)sessions are significantly more in group A than that in in group B.At one month,in group A,the level of hemoglobin,platelet,leukocyte,creatinine,alanine aminotransferase,aspartate transaminase,total bilirubin,prothrombin time and prothrombin activity changed insignificantly(P>0.05).The level of albumin improved significantly(P<0.05).Six months after the treatment,the level of hemoglobin and albumin improved significantly(P<0.05),while others which mentioned above still changed insignificantly(P>0.05).The percentage of patients with Child-Pugh A before treatment vs one month later were 71.43%vs 78.57%.The percentage of patients with Child-Pugh B was still 21.43%and the patient with Child-Pugh C were improved and obtained Child-Pugh B scores.At six month,the percentage of patients with Child-Pugh A and Child-Pugh B were 84.62%and 15.38%,respectively.In addition,Karnofsky performance status score was significantly improved in group A six months later.At one month,in group B,the level of alanine aminotransferase,aspartate transaminase,prothrombin activity,total bilirubin and creatinine changed insignificantly(P>0.05).And the level of hemoglobin,platelet,leukocyte,albumin and prothrombin time improved significantly(P<0.05).At six month,the level of hemoglobin,platelet,leukocyte,albumin,prothrombin time and prothrombin activity improved significantly(P<0.05).And the level of aspartate transaminase,total bilirubin and creatinine still changed not significantly(P>0.05).At one month,the percentage of patients with Child-Pugh A and Child-Pugh B before treatment vs one month later were 60%vs 86.67%,40%vs 13.33%,respectively.At six month,all of the patients with Child-Pugh B were improved and obtained Child-Pugh A scores.Karnofsky performance status score was significantly improved after both one and six months later in group B.A significant correlation was reported between rebleeding and the diameter of esophageal varices in all patients.Conclusion:Endoscopic treatment plus partial splenic embolization(PSE)is safe and effective for the cirrhosis patients with esophageal and gastric variceal bleeding and splenomegaly or hypersplenism.It has a supportive role in improving the Child-Pugh class and Karnofsky performance status score in the near future within six months.Compared with patients who underwent endoscopic treatment only,the level of leukocyte and platelet increased and the EVL sessions reduced more significantly in patients who underwent endoscopic treatment and PSE.