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Lukies M, Clements W. Splenic artery embolisation for splenic injury during colonoscopy: A systematic review. United European Gastroenterol J 2024; 12:44-55. [PMID: 38047383 PMCID: PMC10859723 DOI: 10.1002/ueg2.12498] [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: 07/28/2023] [Accepted: 09/21/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Splenic injury due to colonoscopy is rare, but has high mortality. While historically treated conservatively for low-grade injuries or with splenectomy for high-grade injuries, splenic artery embolisation is increasingly utilised, reflecting modern treatment guidelines for external blunt trauma. This systematic review evaluates outcomes of published cases of splenic injury due to colonoscopy treated with splenic artery embolisation. METHODS A systematic review was performed of published articles concerning splenic injury during colonoscopy treated primarily with splenic artery embolisation, splenectomy, or splenorrhaphy from 1977 to 2022. Datapoints included demographics, past surgical history, indication for colonoscopy, delay to diagnosis, treatment, grade of injury, splenic artery embolisation location, splenic preservation (salvage), and mortality. RESULTS The 30 patients treated with splenic artery embolisation were of mean age 65 (SD 9) years and 67% female, with 83% avoiding splenectomy and 6.7% mortality. Splenic artery embolisation was proximal to the splenic hilum in 81%. The 163 patients treated with splenectomy were of mean age 65 (SD 11) years and 66% female, with 5.5% mortality. Three patients treated with splenorrhaphy of median age 60 (range 59-70) years all avoided splenectomy with no mortality. There was no difference in mortality between splenic artery embolisation and splenectomy cohorts (p = 0.81). CONCLUSIONS Splenic artery embolisation is an effective treatment option in splenic injury due to colonoscopy. Given the known benefits of splenic salvage compared to splenectomy, including preserved immune function against encapsulated organisms, low cost, and shorter hospital length of stay, embolisation should be incorporated into treatment pathways for splenic injury due to colonoscopy in suitable patients.
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Affiliation(s)
- Matthew Lukies
- Department of RadiologyAlfred HealthMelbourneVictoriaAustralia
| | - Warren Clements
- Department of RadiologyAlfred HealthMelbourneVictoriaAustralia
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
- National Trauma Research InstituteMelbourneVictoriaAustralia
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Clements W, Fitzgerald M, Chennapragada SM, Mathew J, Groombridge C, Ban EJ, Lukies MW. A systematic review assessing incorporation of prophylactic splenic artery embolisation (pSAE) into trauma guidelines for the management of high-grade splenic injury. CVIR Endovasc 2023; 6:62. [PMID: 38103054 PMCID: PMC10725392 DOI: 10.1186/s42155-023-00414-6] [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: 10/20/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Splenic artery embolisation (SAE) has become a vital strategy in the modern landscape of multidisciplinary trauma care, improving splenic salvage rates in patients with high-grade injury. However, due to a lack of prospective data there remains contention amongst stakeholders as to whether SAE should be performed at the time of presentation (prophylactic or pSAE), or whether patients should be observed, and SAE only used only if a patient re-bleeds. This systematic review aimed to assess published practice management guidelines which recommend pSAE, stratified according to their quality. METHODS The study was registered and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Medline, PubMed, Cochrane, Embase, and Google Scholar were searched by the study authors. Identified guidelines were graded according to the Appraisal of Guidelines Research and Evaluation II (AGREE-II) instrument. RESULTS Database and internet searches identified 1006 results. After applying exclusion criteria, 28 guidelines were included. The use of pSAE was recommended in 15 guidelines (54%). This included 6 out of 9 guidelines that were high quality (66.7%), 4 out of 9 guidelines that were moderate quality (44.4%), and 3 out of 10 (30%) guidelines that were low quality, p = 0.275. CONCLUSIONS This systematic review showed that recommendation of pSAE is more common in guidelines which are of high quality. However, there is vast heterogeneity of recommended practice guidelines, likely based on individual trauma systems rather than the available evidence. This reflects biases with interpretation of data and lack of multidisciplinary system inputs, including from interventional radiologists.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia.
- National Trauma Research Institute, Melbourne, Australia.
| | - Mark Fitzgerald
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia
- Department of Trauma, Alfred Health, Melbourne, Australia
| | - S Murthy Chennapragada
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
- Department of Medical Imaging, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Joseph Mathew
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia
- Department of Trauma, Alfred Health, Melbourne, Australia
| | - Christopher Groombridge
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia
- Department of Trauma, Alfred Health, Melbourne, Australia
| | - Ee Jun Ban
- National Trauma Research Institute, Melbourne, Australia
- Acute General Surgical Unit, Alfred Health, Melbourne, Australia
| | - Matthew W Lukies
- Department of Radiology, Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, 3004, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia
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Varma D, Brown P, Clements W. Importance of the Mechanism of Injury in Trauma Radiology Decision-Making. Korean J Radiol 2023; 24:522-528. [PMID: 37271206 DOI: 10.3348/kjr.2022.0966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/22/2023] [Accepted: 04/18/2023] [Indexed: 06/06/2023] Open
Affiliation(s)
- Dinesh Varma
- Department of Radiology, Alfred Health, Melbourne, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia.
| | - Patrick Brown
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia
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