Percutaneous transhepatic embolization of gastroesophageal varices combined with partial splenic embolization for variceal bleeding and hypersplenism: a comparison with surgery

Objective: To evaluate the efficacy of the combination of percutaneous transhepatic embolization of gastroesophageal varices (PEGV) and partial splenic embolization (PSE) for the treatment of variceal bleeding. Methods: Fifty patients with cirrhosis who fit in with the requirements of the study were randomly divided into dual-interventional group and surgical group. The patients in dual-interventional group were treated with PEGV together with PSE, and the patients in surgery group were treated with Hassab's operation.After the procedure all the patients in two groups were followed up periodically. The endoscopy, B ultrasonography, liver function tests and hematologic examinations were performed 24 months after the therapy, and the results were statistically analyzed. Results: Fifty patients were enrolled in this study. The procedures of embolization and surgery were successful in all patients. In dual-interventional group, the white blood cell and platelet counts were(2.33 ± 0.65) x 109/ L and (3.63 ± 1.05) x 109/ L respectively before the treatment and were (7.98 ± 3.0) x 109/ L and (163 ± 91) x 109/ L respectively 24 months after the treatment (P < 0.05). The diameter of the portal vein was (1.47 ± 0.25) cm before the treatment and was (1.31 ± 0.23) cm 24 months after the treatment (P < 0.05). The severity of esophageal varices decreased from grade III to lower grade II in 11 patients, and from grade II to lower grade I in 6 patients 24 months after procedure. Portal thrombosis occurred in 1 case. The recurrent bleeding rate was 16% (4 / 25) 24 months after treatment. Three patients died of the recurrent bleeding, one patient died of hepatic failure. In surgical group, the white blood cell and platelet counts were (2.2 ± 0.60) x 109/ L and (41 ± 12.5) x 109/ L before treatment, and were (9.3 ± 2.56) x 109/ L and (321 ± 12.5) x 109/ L 24 months after treatment (P < 0.05). The diameter of the portal vein was (1.43 ± 0.22) cm before the treatment and was (1.28 ± 0.18) cm after the treatment (P < 0.05). The severity of esophageal varices decreased from grade III to lower grade II in 13 patients, and from grade II to lower grade I in 7 patients.Four patients developed portal thrombosis after the procedure. The recurrent bleeding rate was 20% (5 / 25), 2 patients died of hepatic failure after the surgery, 2 died of recurrent bleeding. Conclusion: In treating patients with cirrhosis, the combination of PGEV and PSE, regarded as dual-interventional therapy, is very effective, especially in controlling recurrent bleeding and in improving white blood cell and platelet counts. (authors)