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Percutaneous transhepatic embolization of gastroesophageal varices: results in 400 patients
C L'Herminé1, P Chastanet, O Delemazure
1Department of Radiology, Centre Hospitalier Universitaire, Lille, France.
Insights
Percutaneous transhepatic embolization effectively controlled bleeding esophageal varices in 400 cirrhotic patients. While survival was higher for Child
Area of Science:
- Hepatology
- Interventional Radiology
- Gastroenterology
Background:
- Esophageal varices are a serious complication of cirrhosis, leading to life-threatening bleeding.
- Percutaneous transhepatic embolization (PTE) is an established treatment for variceal hemorrhage.
Purpose of the Study:
- To evaluate the efficacy and safety of PTE in managing bleeding esophageal varices in a large cohort of cirrhotic patients.
Main Methods:
- A 7-year retrospective analysis of 400 cirrhotic patients undergoing PTE for variceal bleeding.
- Embolization agents included bucrylate or absolute ethanol with stainless-steel coils.
- Patient outcomes, including hemorrhage control, survival rates, and complications, were analyzed.
Main Results:
- Hemorrhage was controlled in 83% of emergency PTE cases.
- The 10-day survival rate was 76%, with recurrent bleeding a major cause of mortality.
- Recurrent bleeding rates were higher in Child's class C (70% at 6 months) than Child's class B (38% at 6 months) patients.
- Survival rates were significantly higher for Child's class B patients compared to Child's class C patients over 5 years.
- Technical failure and complication rates were 9% and 7%, respectively, decreasing with experience.
Conclusions:
- PTE is a safe, effective, and relatively easy procedure for controlling acute variceal bleeding in cirrhotic patients.
- Patient prognosis is strongly influenced by Child's classification, with better outcomes in Child's class B.
- While PTE offers immediate control, long-term management of recurrent bleeding remains a challenge.
Abstract:
During a 7-year period, bleeding esophageal varices were treated by means of percutaneous transhepatic embolization in 400 cirrhotic patients, including 258 patients with Child's class C cirrhosis (65%) and 142 patients with Child's class B cirrhosis (35%). Embolization was performed either with bucrylate or with absolute ethanol and stainless-steel coils. Variceal hemorrhage was controlled in 245 (83%) of the 297 patients in whom percutaneous transhepatic embolization was performed as an emergency treatment. The 10-day survival rate in the series was 76%, with 97 deaths occurring shortly after the procedure as a result of recurrent bleeding or liver failure. The actuarial rate of recurrent bleeding was 55% at 6 months (38% Child's class B, 70% Child's class C) and 81% at 2 years (71% Child's class B, 90% Child's class C). One-half the cases of recurrent bleeding were easily controlled by medical treatment; 56% of these patients were still alive at 6 months (79% Child's class B, 42% Child's class C), 48% were alive at 1 year, and 26% were alive at 5 years. Results indicated that the survival rate was significantly higher (p less than .01) in Child's class B patients than in Child's class C patients during the 5-year follow-up period. The overall technical failure and complication rates were 9% and 7%, respectively, but these rates declined progressively as we gained more experience with the procedure. In this large series, transhepatic embolization was a safe, easy-to-perform, and effective treatment for the control of variceal bleeding and was somewhat more efficacious than previously reported.