Minimally invasive devascularization for variceal bleeding that could not be controlled with sclerotherapy

Area of Science:

• Gastroenterology
• Interventional Radiology
• Hepatology

Background:

• Continued bleeding from esophageal varices despite sclerotherapy presents a significant therapeutic challenge.
• Existing treatments often involve high risks associated with major surgery and general anesthesia.

Purpose of the Study:

• To evaluate the efficacy and safety of a minimally invasive devascularization procedure for variceal hemorrhage refractory to sclerotherapy.
• To assess outcomes in patients with advanced liver disease (Child's class B and C).

Main Methods:

• A three-stage devascularization procedure was employed, including splenic artery embolization, esophagogastric variceal thrombosis with portoazygos disconnection, and devascularization of the proximal stomach.
• Fifty consecutive patients with endoscopically proven variceal hemorrhage unresponsive to sclerotherapy were included.

Main Results:

• Hospital survival was achieved in 100% of Child's class B patients and 71% of Child's class C patients.
• One-year survival rates were 94% for Child's class B and 62% for Child's class C patients.
• Rebleeding occurred in 63% of discharged patients, but mortality from rebleeding was low.

Conclusions:

• Minimally invasive devascularization demonstrated a 20% initial hospital mortality, which is superior to emergency surgery for this high-risk group.
• The procedure offers a viable alternative for managing refractory variceal bleeding, with acceptable rebleeding rates compared to other nonshunting therapies.