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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Splenic artery embolisation for portal hypertension in children
Ila V Meisheri1, Paras R Kothari, Anil Kumar
1Department of Paediatric Surgery, B. J. Wadia Children Hospital, India.
Insights
Splenic artery embolisation and variceal sclerotherapy are effective treatments for bleeding esophageal varices in children. Embolisation showed fewer rebleeds and complications compared to sclerotherapy over five years.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
Background:
- Esophageal varices bleeding is a major cause of gastrointestinal hemorrhage in children.
- Portal hypertension is a common underlying condition.
Purpose of the Study:
- To analyze the efficacy of splenic artery embolisation and variceal sclerotherapy for bleeding esophageal varices in children.
- To compare outcomes between embolisation and sclerotherapy.
Main Methods:
- Retrospective analysis of 25 pediatric patients treated for bleeding esophageal varices from 1998-2004.
- Patients were divided into sclerotherapy, combined therapy, and embolisation groups.
- Follow-up was conducted for five years.
Main Results:
- Fifteen patients underwent splenic artery embolisation using steel coils.
- Follow-up demonstrated reduced splenic mass, varices, and hyperdynamic flow.
- Patients treated with embolisation experienced fewer rebleeds and complications than those treated with sclerotherapy.
Conclusions:
- Splenic artery embolisation is a viable treatment option for bleeding esophageal varices.
- Embolisation shows promise in slowing the progression of portal hypertension and its complications.
- Further consideration of embolisation for pediatric patients is warranted.
Background:
Bleeding from esophageal varices is one of the most common causes of serious gastrointestinal haemorrhage in children. We analysed our experience with the use of splenic artery embolisation and variceal sclerotherapy for bleeding oesophageal varices.
Patients And Methods:
Records of all patients treated for bleeding oesophageal varices caused by portal hypertension from 1998 to 2004 were retrospectively analysed. Patients were followed up for five years.
Results:
Out of 25 patients treated, ten belonged to sclerotherapy (group A), eight to combined sclerotherapy and embolisation (group B), and seven to only embolisation (group C). The patients were selected randomly, only two patients who had active bleed recently were directly sclerosed. The splenic artery was embolised at the hilum using steel coils in 15 patients with portal hypertension and hypersplenism. Follow-up findings showed decrease in splenic mass, varices, and hyperdynamic flow.
Conclusion:
In spite of few patients and a short period of follow-up, our results pointed out that a serious consideration should be given to this procedure, as it slowed the sequel of portal hypertension and the complications associated with it. Patients who were embolised and followed up for five years had lesser rebleeds and complications than sclerotherapy patients.
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