Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantationReport as inadecuate




Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation - Download this document for free, or read online. Document in PDF available to download.

Introduction

Upper gastrointestinal bleeding UGIB is a severe and life-threatening complication among patients with portal hypertension PH. Covered transjugular intrahepatic portosystemic shunt TIPS is the treatment of choice for patients with refractory or recurrent UGIB despite pharmacological and endoscopic therapy. In some patients, TIPS implantation is not possible due to co-morbidity or vascular disorders. Spleen embolization SE may be a promising alternative in this setting.

Materials and methods

We retrospectively analyzed 9 patients with PH-induced UGIB who underwent partial SE between 2012 and 2016. All patients met the following criteria: i upper gastrointestinal hemorrhage with primary or secondary failure of endoscopic interventions and ii TIPS implantation not possible. Each patient was followed for at least 6 months after embolization.

Results

Five patients 56% suffered from cirrhotic PH, 4 patients 44% from non-cirrhotic PH. UGIB occured in terms of refractory hemorrhage from gastric varices 3-9; 33%, hemorrhage from esophageal varices 3-9; 33%, and finally, hemorrhage from portal-hypertensive gastropathy 3-9; 33%. None of the patients treated with partial SE experienced re-bleeding episodes or required blood transfusions during a total follow-up time of 159 months, including both patients with cirrhotic- and non-cirrhotic PH.

Discussion

Partial SE, as a minimally invasive intervention with low procedure-associated complications, may be a valuable alternative for patients with recurrent PH-induced UGIB refractory to standard therapy.



Author: Matthias Buechter, Alisan Kahraman, Paul Manka, Guido Gerken, Alexander Dechêne, Ali Canbay, Axel Wetter, Lale Umutlu, Jens M. T

Source: http://plos.srce.hr/



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