Endoscopic variceal ligation (EVL) combined with partial splenic embolization (PSE).

Area of Science:

• Gastroenterology
• Interventional Radiology
• Hepatology

Background:

• Esophageal varices pose a significant risk of bleeding in patients with portal hypertension.
• Endoscopic variceal ligation (EVL) is a standard treatment, but recurrence rates can be high.
• Partial splenic embolization (PSE) is an adjunct therapy aimed at reducing portal pressure.

Purpose of the Study:

• To evaluate the effectiveness of combining partial splenic embolization (PSE) with endoscopic variceal ligation (EVL) in reducing the recurrence rate of esophageal varices.
• To compare the recurrence rates of PSE combined with EVL against EVL alone and endoscopic injection sclerotherapy (EIS) alone.

Main Methods:

• A retrospective study comparing three groups of patients with completely eradicated esophageal varices: PSE + EVL (n=31), EVL alone (n=25), and EIS alone (n=33).
• Cumulative recurrence rates were monitored over 6 months, 1 year, and 2 years.
• Analysis included stratification by Child's classification (A, B, C).

Main Results:

• The PSE + EVL group showed significantly lower recurrence rates at 6 months (21.1%), 1 year (37.0%), and 2 years (58.1%) compared to the EVL alone group (58.1%, 70.7%, 80.4% respectively).
• Recurrence rates in the PSE + EVL group tended to be lower than the EIS group across all time points.
• In Child B patients, PSE + EVL demonstrated significantly lower recurrence rates than EVL alone (p=0.032).

Conclusions:

• Partial splenic embolization combined with endoscopic variceal ligation is a highly effective therapy for achieving long-term complete eradication of esophageal varices.
• The combination therapy shows particular benefit in patients with Child B liver disease.
• This approach offers a promising strategy to reduce variceal recurrence and associated complications.