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Li J, Wei M, Zeng Y, He C, Sun M, Zhang J, Zhang A, Zhou T, Gao Y. Efficacy of endoscopic therapy combined with partial splenic embolization versus Hassab's operation for patients with liver cirrhosis with esophageal variceal bleeding and hypersplenism: a multicenter cohort study based on propensity score matching. Surg Endosc 2024:10.1007/s00464-024-11148-4. [PMID: 39138685 DOI: 10.1007/s00464-024-11148-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 08/04/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND The prognosis comparison between endoscopic therapy + partial splenic embolization (PSE) and Hassab's operation is unclear in the treatment of esophageal variceal bleeding in patients with liver cirrhosis. This study aimed to compare the outcome of endoscopic therapy + PSE (EP) with a combination of splenectomy + pericardial devascularization procedure, known as Hassab's operation (SH) for esophageal variceal bleeding in patients with liver cirrhosis with hypersplenism. METHODS We enrolled 328 patients, including 125 and 203 patients who underwent EP and SH, respectively. Each group consisted of 110 patients after propensity score matching (PSM). Subsequently, we recorded and analyzed bleeding episodes and mortality in 6 months and 1, 2, and 5 years after therapies. RESULTS The median follow-up time in the EP and SH groups was 53 and 64 months, respectively. Bleeding incidence 6 months after therapies in the EP group was lower than that in the SH group (1.8% vs. 10.0%, P = 0.010). Additionally, complications in the perioperative period were not significantly different (0% vs. 3.6%, P = 0.008). However, the bleeding rate between the two groups was not significantly different at 1, 2, and 5 years after therapies (7.3% vs. 12.7%, P = 0.157; 10.9% vs. 16.4%, P = 0.205; 30.6% vs. 31.8%, P = 0.801), as well as mortality rate (4.5% vs 7.3%, P = 0.571). CONCLUSION Compared with SH therapy, the bleeding rate 6 months after EP therapy was lower, but the long-term bleeding rate was similar.
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Affiliation(s)
- Jinhou Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Department of Gastroenterology, Taian City Central Hospital, Taian, Shandong, China
| | - Min Wei
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Department of Gastroenterology, Affiliated Hospital of Shandong Second Medical University, Weifang, Shandong, China
| | - Yunqing Zeng
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Chao He
- Department of Gastrointestinal Surgery, Taian Central Hospital, Taian, Shandong, China
| | - Ming Sun
- Department of Oncological Surgery, Taian City Central Hospital, Taian, Shandong, China
| | - Jing Zhang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Anzhong Zhang
- Department of Gastroenterology, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Tao Zhou
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China.
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| | - Yanjing Gao
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
- The Institute of Portal Hypertension, Shandong University, Jinan, Shandong, China.
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Büttner L, Pick L, Jonczyk M, Fehrenbach U, Collettini F, Auer TA, Schnapauff D, De Bucourt M, Wieners G, Gebauer B, Aigner A, Böning G. Shunt dysfunction and mortality after transjugular intrahepatic portosystemic shunt (TIPS) in patients with portal hypertension. Insights Imaging 2024; 15:193. [PMID: 39112682 PMCID: PMC11306489 DOI: 10.1186/s13244-024-01768-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/07/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES Transjugular intrahepatic portosystemic shunt (TIPS) is a catheter-based, minimally invasive procedure to reduce portal hypertension. The aim of the study was to investigate dysfunction and mortality after TIPS and to identify factors associated with these events. METHODS A retrospective analysis of 834 patients undergoing TIPS implantation in a single center from 1993-2018 was performed. Cumulative incidence curves were estimated, and frailty models were used to assess associations between potentially influential variables and time to dysfunction or death. RESULTS 1-, 2-, and 5-year mortality rates were 20.9% (confidence interval (CI) 17.7-24.1), 22.5% (CI 19.1-25.8), and 25.0% (CI: 21.1-28.8), 1-year, 2-year, and 5-year dysfunction rates were 28.4% (CI 24.6-32.3), 38.9% (CI 34.5-43.3), and 52.4% (CI 47.2-57.6). The use of covered stents is a protective factor regarding TIPS dysfunction (hazard ratio (HR) 0.47, CI 0.33-0.68) but does not play a major role in survival (HR 0.95, CI 0.58-1.56). Risk factors for mortality are rather TIPS in an emergency setting (HR 2.78, CI 1.19-6.50), a previous TIPS dysfunction (HR 2.43, CI 1.28-4.62), and an increased Freiburg score (HR 1.45, CI 0.93-2.28). CONCLUSION The use of covered stents is an important protective factor regarding TIPS dysfunction. Whereas previous TIPS dysfunction, emergency TIPS implantation, and an elevated Freiburg score are associated with increased mortality. Awareness of risk factors could contribute to a better selection of patients who may benefit from a TIPS procedure and improve clinical follow-up with regard to early detection of thrombosis/stenosis. CRITICAL RELEVANCE STATEMENT The use of covered stents reduces the risk of dysfunction after transjugular intrahepatic portosystemic shunt (TIPS). TIPS dysfunction, emergency TIPS placement, and a high Freiburg score are linked to higher mortality rates in TIPS patients. KEY POINTS The risk of dysfunction is higher for uncovered stents compared to covered stents. Transjugular intrahepatic portosystemic shunt dysfunction increases the risk of instantaneous death after the intervention. A higher Freiburg score increases the rate of death after the intervention. Transjugular intrahepatic portosystemic shunt implantations in emergency settings reduce survival rates.
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Affiliation(s)
- Laura Büttner
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Charitéplatz 1, 10117, Berlin, Germany.
| | - Lisa Pick
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Jonczyk
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Uli Fehrenbach
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Federico Collettini
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Timo Alexander Auer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dirk Schnapauff
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Maximilian De Bucourt
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Gero Wieners
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Bernhard Gebauer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Annette Aigner
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Georg Böning
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Charitéplatz 1, 10117, Berlin, Germany
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Leideck P, Nkontchou G, Elkrief L, Erard D, d'Alteroche L, Radenne S, Billioud C, Meszaros M, Regnault D, Pageaux GP, Hilleret MN, Tripon S, Guillaud O, Ollivier-Hourmand I, Ganne-Carrié N, Dumortier J. The role and evolution of partial splenic embolization over three decades: A multicentric retrospective single cohort study of 90 patients from French nationwide experience. Clin Res Hepatol Gastroenterol 2024; 48:102355. [PMID: 38679291 DOI: 10.1016/j.clinre.2024.102355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/10/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Partial splenic embolization (PSE) has been proposed to treat the consequences of hypersplenism in the context of portal hypertension, especially thrombocytopenia. However, a high morbidity/mortality rate has made this technique unpopular. We conducted a multicenter retrospective nationwide French study to reevaluate efficacy and tolerance. METHODS All consecutive patients who underwent PSE for hypersplenism and portal hypertension in 7 tertiary liver centers between 1998 and 2023 were included. RESULTS The study population consisted of 91 procedures in 90 patients, with a median age of 55.5 years [range 18-83]. The main cause of portal hypertension was cirrhosis (84.6 %). The main indications for PSE were (1) an indication of medical treatment or radiological/surgical procedure in the context a severe thrombocytopenia (59.3 %), (2) a chronic hemorrhagic disorder associated with a severe thrombocytopenia (18.7 %), and (3) a chronic pain associated with a major splenomegaly (9.9 %). PSE was associated with a transjugular intrahepatic portosystemic shunt in 20 cases. Median follow-up after PSE was 41.9 months [0.5-270.5]. Platelet count increased from a median of 48.0 G/L [IQR 37.0; 60.0] to 100.0 G/L [75.0; 148]. Forty-eight patients (52.7 %) had complications after PSE; 25 cases were considered severe (including 7 deaths). A Child-Pugh B-C score (p < 0.02) was significantly associated with all complications, a history of portal vein thrombosis (p < 0.01), and the absence of prophylactic antibiotherapy (p < 0.05) with severe complications. CONCLUSION Our results strongly confirm that PSE is very effective, for a long time, although a quarter of the patients experienced severe complications. Improved patient selection (exclusion of patients with portal vein thrombosis and decompensated cirrhosis) and systematic prophylactic antibiotherapy could reduce morbidity and early mortality in the future.
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Affiliation(s)
- Paul Leideck
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France
| | - Gisèle Nkontchou
- Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Service d'Hépato-Gastroentérologie, Bobigny, France
| | - Laure Elkrief
- CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France
| | - Domitille Erard
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | - Louis d'Alteroche
- CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France
| | - Sylvie Radenne
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | - Claire Billioud
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | - Magdalena Meszaros
- CHU Saint Eloi, Département d'Hépatologie et Transplantation Hépatique, Montpellier, France
| | - David Regnault
- CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France
| | | | | | - Simona Tripon
- CHRU Hautepierre, Service d'Hépato-Gastroentérologie, Strasbourg, France
| | - Olivier Guillaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France; Clinique de la Sauvegarde, Ramsay Générale de Santé, Lyon, France
| | | | - Nathalie Ganne-Carrié
- Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Service d'Hépato-Gastroentérologie, Bobigny, France
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France.
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Gogna A, Tan HK, Too CW, Chang Pik Eu J. IR management of portal hypertension complications. Clin Liver Dis (Hoboken) 2023; 22:75-79. [PMID: 37663554 PMCID: PMC10473336 DOI: 10.1097/cld.0000000000000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/17/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Apoorva Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Hiang Keat Tan
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Jason Chang Pik Eu
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
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Zhan PC, Li Z, Li X, Lv PJ, Zhang YY, Yu P, Ji K, Shi Y, Ye SW, Xie BC, Gao JB, Zhou PL, Wu G. A Nomogram to Predict the Risk of Stent Dysfunction After TIPS in Patients with Hepatitis B Cirrhosis. Acad Radiol 2022; 29:1532-1540. [PMID: 35216866 DOI: 10.1016/j.acra.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/13/2022] [Accepted: 01/23/2022] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a nomogram for the prediction of stent dysfunction after transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with hepatitis B cirrhosis. MATERIALS AND METHODS From 2012 to 2020, 355 patients with hepatitis B cirrhosis who underwent TIPS placements were enrolled in this study. A multivariable logistic regression analysis was applied to determine independent risk factors for the nomogram construction. Discrimination, calibration, and clinical usefulness of the prediction model were assessed by using receiver operating characteristic curves, calibration scatter plots, and a decision curve analysis (DCA). RESULTS Independent factors for TIPS stent dysfunction included diabetes, previous splenectomy, the shunting branch of the portal vein, and stent position, which were used to construct the nomogram. The AUC values in the training and validation cohorts were 0.817 (95% CI: 0.731-0.903) and 0.804 (95% CI: 0.673-0.935), respectively, which suggested a good predictive ability. The calibration curves in both cohorts revealed good agreement between the predictions and actual observations. The DCA curve indicated that when the threshold probability ranged from 2% to 88%, the nomogram could provide clinical usefulness and a net benefit. CONCLUSION The nomogram that we developed could be conveniently used to predict TIPS stent dysfunction in patients with hepatitis B cirrhosis.
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Affiliation(s)
- Peng-Chao Zhan
- Department of Radiology, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Zhen Li
- Department of Interventional Radiology, Zhengzhou University First Affiliated Hospital, No.1 Jianshe Road, Zhengzhou 450052, China.
| | - Xin Li
- Department of Interventional Radiology, Zhengzhou University First Affiliated Hospital, No.1 Jianshe Road, Zhengzhou 450052, China
| | - Pei-Jie Lv
- Department of Radiology, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Yu-Yuan Zhang
- Department of Interventional Radiology, Zhengzhou University First Affiliated Hospital, No.1 Jianshe Road, Zhengzhou 450052, China
| | - Peng Yu
- Department of Interventional Radiology, Zhengzhou University First Affiliated Hospital, No.1 Jianshe Road, Zhengzhou 450052, China
| | - Kun Ji
- Department of Interventional Radiology, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yang Shi
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shu-Wen Ye
- Department of Interventional Radiology, Zhengzhou University First Affiliated Hospital, No.1 Jianshe Road, Zhengzhou 450052, China
| | - Bing-Can Xie
- Department of Interventional Radiology, Zhengzhou University First Affiliated Hospital, No.1 Jianshe Road, Zhengzhou 450052, China
| | - Jian-Bo Gao
- Department of Radiology, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Peng-Li Zhou
- Department of Interventional Radiology, Zhengzhou University First Affiliated Hospital, No.1 Jianshe Road, Zhengzhou 450052, China
| | - Gang Wu
- Department of Interventional Radiology, Zhengzhou University First Affiliated Hospital, No.1 Jianshe Road, Zhengzhou 450052, China
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Cannella R, Tselikas L, Douane F, Cauchy F, Rautou PE, Duran R, Ronot M. Imaging-guided interventions modulating portal venous flow: evidence and controversies. JHEP REPORTS : INNOVATION IN HEPATOLOGY 2022; 4:100484. [PMID: 35677591 PMCID: PMC9168703 DOI: 10.1016/j.jhepr.2022.100484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 12/07/2022]
Abstract
Portal hypertension is defined by an increase in the portosystemic venous gradient. In most cases, increased resistance to portal blood flow is the initial cause of elevated portal pressure. More than 90% of cases of portal hypertension are estimated to be due to advanced chronic liver disease or cirrhosis. Transjugular intrahepatic portosystemic shunts, a non-pharmacological treatment for portal hypertension, involve the placement of a stent between the portal vein and the hepatic vein or inferior vena cava which helps bypass hepatic resistance. Portal hypertension may also be a result of extrahepatic portal vein thrombosis or compression. In these cases, percutaneous portal vein recanalisation restores portal trunk patency, thus preventing portal hypertension-related complications. Any portal blood flow impairment leads to progressive parenchymal atrophy and triggers hepatic regeneration in preserved areas. This provides the rationale for using portal vein embolisation to modulate hepatic volume in preparation for extended hepatic resection. The aim of this paper is to provide a comprehensive evidence-based review of the rationale for, and outcomes associated with, the main imaging-guided interventions targeting the portal vein, as well as to discuss the main controversies around such approaches.
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Wu HM, Huang SQ, Wan YM, Li YH, Xu Y. Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt (Tips) Creation Using Fluency Versus Viatorr Stent-Grafts: A Single-Centre Retrospective Study. Cardiovasc Intervent Radiol 2022; 45:552-562. [PMID: 35274174 DOI: 10.1007/s00270-022-03102-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/13/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To investigate the effects of transjugular intrahepatic portosystemic shunt (TIPS) creation using Fluency versus Viatorr stent-grafts on the long-term clinical outcomes. MATERIALS AND METHODS This was a single-center retrospective study from January 2010 to October 2021 in 213 patients receiving TIPS with Fluency (Fluency group, n = 154) versus Viatorr (Viatorr group, n = 59) stent-grafts. Inclusion criteria were: age > 18 years old and TIPS creation for variceal hemorrhage. Exclusion criteria were: age > 80 years old, concomitant chronic heart or lung disease, active tuberculosis or human immunodeficiency virus infection, extrahepatic malignancy, alcohol dependence, TIPS created outside of our hospital, without any follow-up data, or decline to participate. The primary outcome was primary patency rate and its associated risk factors. RESULTS The 5-year cumulative primary patency rate was significantly higher in Viatorr group than in Fluency group (89.0% vs. 19.6%, p < 0.001), whereas the 5-year cumulative transplant-free survival rate (62.3% vs. 62.2%, p = 0.636) was comparable between two groups. Cox-regression models revealed that group (hazard ratio [HR]4.029, 95% confidence interval [CI] 1.486-10.927, p = 0.006), use of bare stents (HR 3.307, 95% CI 1.903-5.747, p < 0.001), and baseline portal vein thrombosis (HR 0.248, 95% CI 0.149-0.412, p < 0.001) were significantly associated with shunt patency. Incidences of adverse events were not significantly different between two groups (p > 0.05). CONCLUSIONS TIPS creation using Viatorr stent-grafts is superior to using Fluency stent-grafts in terms of higher long-term primary patency rate but similar transplant-free survival rate.
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Affiliation(s)
- Hua-Mei Wu
- Gastroenterology Department II, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China
| | - Song-Quan Huang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China
| | - Yue-Meng Wan
- Gastroenterology Department II, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China.
| | - Yu-Hua Li
- Gastroenterology Department II, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China
| | - Ying Xu
- Gastroenterology Department II, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China
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Chen XL, Yao X, Yang GD, Qin JP. Applications of vascular interventions in hypersplenism in liver cirrhosis. Shijie Huaren Xiaohua Zazhi 2022; 30:140-146. [DOI: 10.11569/wcjd.v30.i3.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cirrhosis is a common cause of secondary hypersplenism. Hypersplenism often leads to a decrease in peripheral blood cells, and when the numbers of leukocytes and platelets are severely reduced, patients are prone to spontaneous infections and bleeding, which can aggravate the disease and increase the risk of death. The mechanism of hypersplenism in cirrhosis is not well understood, and there is no standard indication or recommended method for the treatment of hypersplenism. Clinical treatment options for hypersplenism include splenectomy, vascular intervention, local thermal ablation, and splenic artery ligation. Vascular interventions mainly involve transjugular intrahepatic portosystemic shunt (TIPS) and partial splenic embolization (PSE). TIPS is an effective method to treat the complications of portal hypertension in cirrhosis, which can effectively reduce portal pressure, but whether it can relieve hypersplenism is still controversial. PSE can relieve hypersplenism to a certain extent. TIPS combined with PSE can effectively reduce portal hypertension and relieve hypersplenism to a certain extent. This article reviews the applications of vascular interventions in hypersplenism in cirrhosis.
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Affiliation(s)
- Xue-Ling Chen
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xin Yao
- Department of Gastroenterology, General Hospital of Western War Zone, Chinese People's Liberation Army, Chengdu 610083, Sichuan Province, China
| | - Guo-Dong Yang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jian-Ping Qin
- Department of Gastroenterology, General Hospital of Western War Zone, Chinese People's Liberation Army, Chengdu 610083, Sichuan Province, China
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Sun X, Zhang A, Zhou T, Wang M, Chen Y, Zhou T, Chen X, Xiu A, Peng Z, Cheng B, Liu X, Gao Y. Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial. Hepatol Int 2021; 15:741-752. [PMID: 33638769 PMCID: PMC8286949 DOI: 10.1007/s12072-021-10155-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/30/2021] [Indexed: 12/12/2022]
Abstract
Background Global research on endoscopic therapies in combination with partial splenic embolization (PSE) for variceal hemorrhage (VH) is limited. Therefore, we aimed to evaluate the efficacy and safety of endoscopy plus PSE (EP) treatment in comparison to endoscopic (E) treatment for the secondary prophylaxis of VH in cirrhosis patients with hypersplenism. Methods Cirrhosis patients with hypersplenism (platelet count < 100, 000/µL) and those who had recovered from an episode of VH were enrolled in a multicenter randomized controlled trial. The participants were randomly assigned into EP and E groups in a 1:1 ratio. The primary endpoint was variceal rebleeding, and the secondary endpoints were severe variceal recurrence and mortality during the 2-year follow-up. Hematological indices, serum biochemical parameters, and the Child–Pugh score were measured at each time point. Results From June 2016 to December 2019, 108 patients were enrolled in the study, among which 102 patients completed the protocol (51 in EP and 51 in E group). The rebleeding rate of the varices was significantly reduced in the EP group compared to that in the E group during the 2 years (16% vs. 31%, p < 0.001). The EP group showed a significantly lower variceal recurrence rate than the E group (22% vs. 67%, p < 0.001). The COX proportional hazard models revealed that grouping was an independent predictor for variceal rebleeding (H = 0.122, 95% CI 0.055–0.270, p < 0.001) and variceal recurrence (hazard ratio, H = 0.160, 95% CI 0.077–0.332, p < 0.001). The peripheral blood cell count, Child–Pugh class/score, albumin concentration, and coagulation function in the EP group improved significantly compared to the values observed in the E group at any time point (p < 0.05). Conclusions The EP treatment was more effective in preventing variceal rebleeding and variceal recurrence than the conventional E treatment during the secondary prophylaxis of VH in cirrhosis patients with hypersplenism. Furthermore, the EP treatment could significantly increase the peripheral blood cell count and albumin concentration and also improved the coagulation function and the Child–Pugh score. Clinical trials registration Trial registration number ClincialTrials.gov: NCT02778425. The URL of the clinical trial: https://clinicaltrials.gov/ Supplementary Information The online version contains supplementary material available at 10.1007/s12072-021-10155-0.
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Affiliation(s)
- Xin Sun
- Department of Gastroenterology, Qilu Hospital of Shandong University, Wenhua Xi Road, 107, Jinan City, 250012, Shandong Province, People's Republic of China
| | - Anzhong Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan City, 250021, Shandong Province, China
| | - Tao Zhou
- Department of Gastroenterology, Qilu Hospital of Shandong University, Wenhua Xi Road, 107, Jinan City, 250012, Shandong Province, People's Republic of China
| | - Minghui Wang
- Department of Gastroenterology, The 960th Hospital of the PLA Joint Logistics Support Force, Shifan Road, 25, Jinan City, 250031, Shandong Province, People's Republic of China
| | - Yong Chen
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan City, 250021, Shandong Province, China
| | - Ting Zhou
- Department of Gastroenterology, Qilu Hospital of Shandong University, Wenhua Xi Road, 107, Jinan City, 250012, Shandong Province, People's Republic of China
| | - Xiaoning Chen
- Department of Gastroenterology, Qilu Hospital of Shandong University, Wenhua Xi Road, 107, Jinan City, 250012, Shandong Province, People's Republic of China
| | - Aiyuan Xiu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Wenhua Xi Road, 107, Jinan City, 250012, Shandong Province, People's Republic of China
| | - Zhi Peng
- Department of Gastroenterology, Qilu Hospital of Shandong University, Wenhua Xi Road, 107, Jinan City, 250012, Shandong Province, People's Republic of China
| | - Baoquan Cheng
- Department of Gastroenterology, Qilu Hospital of Shandong University, Wenhua Xi Road, 107, Jinan City, 250012, Shandong Province, People's Republic of China
| | - Xiaofeng Liu
- Department of Gastroenterology, The 960th Hospital of the PLA Joint Logistics Support Force, Shifan Road, 25, Jinan City, 250031, Shandong Province, People's Republic of China.
| | - Yanjing Gao
- Department of Gastroenterology, Qilu Hospital of Shandong University, Wenhua Xi Road, 107, Jinan City, 250012, Shandong Province, People's Republic of China.
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10
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Li Y, Liu Z, Liu C. Efficacy and safety of laparoscopic splenectomy for hypersplenism secondary to portal hypertension after transjugular intrahepatic portosystemic shunt. BMC Gastroenterol 2021; 21:61. [PMID: 33573590 PMCID: PMC7879518 DOI: 10.1186/s12876-021-01647-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic splenectomy (LS) being used after Transjugular intrahepatic portosystemic shunt (TIPS) has not been reported. This report aims to explore the feasibility, safety, and potential efficacy of LS after TIPS hypersplenism secondary to portal hypertension (PHT). Methods We retrospectively reviewed a series of six patients who underwent LS after TIPS for hypersplenism secondary to PHT between 2014 and 2020. The perioperative data and patients’ clinical outcomes were recorded. Results LS was successfully performed in all patients. Hypersplenism was corrected after LS in all six patients. Postoperative prothrombin time, prothrombin activity, international normalized ratio, and total bilirubin showed a trend toward improvement. The preoperative and 1-month postoperative albumin and activated partial thromboplastin levels showed no significant difference. Plasma ammonia level and thromboelastography indicators were ameliorated in two limited recorded patients. No postoperative complications such as subphrenic abscess, portal vein thrombosis, variceal bleeding, hepatic encephalopathy, and liver failure occurred during the 1-month follow-up period. Conclusion LS following TIPS is feasible, safe, and beneficial for patients with hypersplenism secondary to PHT. The following LS not only corrects the hypersplenism, but also has the potential to improve liver function.
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Affiliation(s)
- Yingying Li
- Second Clinical College, Department of Surgery, Chongqing Medical University, 1 Medical College Road, Yuzhong District, Chongqing, China
| | - Zuojin Liu
- Department of Hepatobiliary Surgery, Chongqing Medical University Affiliated Second Hospital, 74 Linjiang Road, Yuzhong District, Chongqing, China.
| | - Chang'an Liu
- Department of Hepatobiliary Surgery, Chongqing Medical University Affiliated Second Hospital, 74 Linjiang Road, Yuzhong District, Chongqing, China
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11
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E Frenk N, Bochnakova T, Ganguli S, Mercaldo N, S Allegretti A, S Pratt D, Yamada K. Small-diameter TIPS combined with splenic artery embolization in the management of refractory ascites in cirrhotic patients. Diagn Interv Radiol 2021; 27:232-237. [PMID: 33517259 DOI: 10.5152/dir.2021.19530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Maximally decreasing portal pressures with transjugular intrahepatic portosystemic shunt (TIPS) is associated with improved ascites control but also increased encephalopathy incidence. Since splenic venous flow contributes to portal hypertension, we assessed if combining small-diameter TIPS with splenic artery embolization could improve ascites while minimizing encephalopathy. METHODS Fifty-five patients underwent TIPS creation for refractory ascites. Subjects underwent creation of 8 mm TIPS followed by proximal splenic artery embolization (group A, n=8), or of 8 mm (group B, n=6) or 10 mm TIPS (group C, n=41) without splenic embolization. Data were retrospectively reviewed. RESULTS In group A, median portosystemic gradient decreased from 19 mmHg to 9 mmHg after TIPS, and 8 mmHg after subsequent splenic artery embolization. In groups B and C, gradient decreased from 15 mmHg to 8 mmHg and 16 mmHg to 6 mmHg. All patients except for one in group A and two in C had greater than 50% reduction in the number of paracenteses in 3 months. Any postprocedural encephalopathy incidence was 62%, 50%, 83% in groups A, B, and C, respectively. Overall, 20% of subjects with 10 mm TIPS required TIPS reduction/closure compared to 7% of subjects with 8 mm TIPS. CONCLUSION We found that 8 mm diameter TIPS provided similar ascites control compared to 10 mm TIPS regardless of splenic embolization. While more patients with 10 mm TIPS required reduction/closure for severe encephalopathy, the study was underpowered for definitive assessment. Splenic embolization might have the potential to further decrease portosystemic gradient and ascites as an alternative to dilation of TIPS to 10 mm minimizing the risk of encephalopathy, but larger studies are warranted.
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Affiliation(s)
- Nathan E Frenk
- Division of Interventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Teodora Bochnakova
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Oregon, USA
| | - Suvranu Ganguli
- Division of Interventional Radiology, Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nathaniel Mercaldo
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew S Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel S Pratt
- Liver Center and Division of Gastrointestinal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kei Yamada
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Leung E, Maingard J, Yeh J, Lee MJ, Brooks DM, Asadi H, Burrows DA, Kok HK. Contemporary endovascular management of splenic vascular pathologies. Clin Radiol 2020; 75:960.e23-960.e34. [PMID: 32819705 DOI: 10.1016/j.crad.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
The spleen is a commonly injured organ and the splenic vasculature is also susceptible to inflammation and trauma, often resulting in aneurysm formation. Splenic artery aneurysms carry a high risk of rupture and are associated with high mortality and morbidity. Due to the advances in endovascular techniques and devices, endovascular management of splenic vascular pathologies is now considered a first-line strategy. Endovascular embolisation and advance techniques including balloon- or stent-assisted coil embolisation enables minimally invasive management option while preserving splenic function.
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Affiliation(s)
- E Leung
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia.
| | - J Maingard
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - J Yeh
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - M J Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D M Brooks
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - H Asadi
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - D A Burrows
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - H K Kok
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
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