Research On Partial Splenic Embolization Combined With Endoscopy To Treat Acute Variceal Bleeding Accompanied With Hypersplenism In Cirrhosis Patients

ObjectiveThis study aimed to compare the efficacy of Partial Splenic Embolization(PSE)combined with endoscopic therapy versus endoscopic therapy alone in cirrhosis patients with Acute Variceal Bleeding(AVB)accompanied with hypersplenism.MethodsPatients with AVB accompanied with hypersplenism attending Qilu Hospital of Shandong University,960th Hospital of the People’s Liberation Army and Shandong Provincial Hospital from June 2016 to June 2022 were prospectively enrolled and randomly allocated to either the endoscopic therapy+PSE group(EP group)or the endoscopic intervention group(E group)in a 1:1 ratio.The primary study endpoint was rebleeding of varices during follow-up and the secondary study endpoints were recurrence of varices,death and adverse events.Peripheral blood counts,liver function,coagulation and Child-Pugh scores were also compared and analyzed between the groups.The inclusion criteria were as follows:(1)age between 18-75 years;(2)liver cirrhosis diagnosis based on clinical,laboratory,and imaging studies;(3)endoscopic therapy within 24 hours of admission in AVB patients;and(4)splenomegaly and thrombocytopenia(platelets<100×109/L).The exclusion criteria were as follows:(1)prior treatment with splenectomy,PSE,Transjugular Intrahepatic Portosystemic Shunt(TIPS),Endoscopic Variceal Ligation(EVL),Endoscopic Injection Sclerotherapy(EIS),Balloon-Occluded Retrograde Transvenous Obliteration(BRTO),or Non-selective beta-blockers(NSBB);(2)isolated gastric or ectopic variceal bleeding;(3)hepatocellular carcinoma or other malignancy;(4)patients with obvious hepatic encephalopathy who are unable to cooperate or liver failure;and(5)inability or refusal to sign an informed consent form.ResultsA total of 114 patients were prospectively included,of whom 110 completed the trial(55 in the EP group and 55 in the E group).The risk of variceal rebleeding at 5 years was significantly lower in the EP group compared to the E group(19.3%vs 36.8%,P=0.013),and Cox multivariate analysis showed that the independent risk factor affecting variceal rebleeding in patients were treatment method(HR=0.333,95%CI:0.154-0.719,P=0.005)and degree of esophageal varices(HR=0.166,95%CI:0.035-0.776,P=0.022).The risk of variceal recurrence at 5 years was significantly lower in the EP group compared to the E group(P<0.001).16 cases(28.1%)in the EP group and 36 cases(63.2%)in the E group developed with new high-risk varices(HRV).The hazard ratio of varices recurrence was 3.18 times in the E group than in the EP group,with a 95%confidence interval(0.172-0.573).Peripheral blood counts,albumin levels,coagulation function and Child-Pugh class/score all improved significantly in the EP group during the follow-up and were statistically different(P<0.05).ConclusionsCompared to endoscopic therapy alone,the rate of variceal rebleeding and recurrence was significantly reduced in cirrhosis patients with hypersplenism who suffered from AVB treated with endoscopic combined PSE.Meanwhile,peripheral blood counts,liver function,coagulation and Child-Pugh scores were also improved.Therefore,endoscopic combined PSE therapy is a safe and effective treatment for patients with Child-Pugh class A and B cirrhotic AVB complicated by hypersplenism.