Endoscopic variceal ligation (EVL) combined with partial splenic embolization (PSE).
OBJECTIVE
The effectiveness of reducing the recurrence rate of esophageal varices by combining partial splenic embolization (PSE) with endoscopic variceal ligation (EVL) was investigated.


METHODS
Patients with complete eradication of esophageal varices were collected as study cases with the following results: 31 cases with PSE and EVL (PSE+EVL group), 25 cases with EVL alone (EVL group), and 33 cases with EIS alone (EIS group). The cumulative recurrence rates were obtained by observing new varices.


RESULTS
The cumulative recurrence rates at 6 months were 21.1% in the PSE+EVL group, 58.1% in the EVL group and 32.5% in the EIS group. Those at 1 year were 37.0%, 70.7% and 50.2%, respectively, and those at 2 years were 58.1%, 80.4% and 73.0%, respectively. For all 3 time periods, recurrence rates of the PSE+EVL group were significantly lower than those of the EVL group (p=0.042). Cumulative rates in the PSE+EVL group tended to be lower than those in the EIS group. Further analysis was made on the comparative recurrence rates of the 3 groups, according to Child's classification. The cumulative recurrence rates in Child A cases did not significantly differ between the 3 groups. Cumulative rates in Child B cases were significantly lower in the PSE+EVL group than in the EVL group (p=0.032), and those in the PSE+EVL group tended to be lower than those in the EIS group. These trends were observed between the PSE+EVL group and the EVL group in Child C cases, while cumulative rates did not show differences between the PSE+EVL group and the EIS group.


CONCLUSIONS
It was inferred that PSE-combined EVL therapy is a very effective therapy for achieving long-term complete eradication of esophageal varices.
Taniai
N
N
Department of Gastroenterology, Nippon Medical School Hospital of Tamanagayama, Japan.
Onda
M
M
Tajiri
T
T
Toba
M
M
Yoshida
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013157:Splenic Artery