Prevention of variceal recurrence, bleeding, and death in cirrhosis patients with hypersplenism, especially those with severe thrombocytopenia.
OBJECTIVE
We investigated the impact of different treatments on the prognosis of cirrhosis patients with esophageal varices and thrombocytopenia.


METHODS
This prospective study enrolled 52 cirrhosis patients with esophageal varices and hypersplenism (platelet count < 50,000/mm3). In 26 patients, endoscopic variceal ligation plus partial splenic embolization were performed, while endoscopic variceal ligation alone was done in 26 patients. Endoscopic variceal ligation was repeated until complete eradication of varices was achieved. Partial splenic embolization was performed using the Seldinger method and embolic material was injected until a 60% to 80% reduction of splenic blood flow was achieved. The primary endpoints during the follow-up period included recurrence of varices, variceal bleeding, and death.


RESULTS
Comparison of endoscopic variceal ligation plus partial splenic embolization with endoscopic variceal ligation alone by multivariate analysis showed a relative risk ratio of 0.390 (95% CI [0.178-0.854]; p = 0.024) for new varices, 0.191 (95% CI [0.047-0.780]; p = 0.021) for variceal bleeding, and 0.193 (95% CI [0.053-0.699]; p = 0.012) for death.


CONCLUSIONS
These results suggest that endoscopic variceal ligation plus partial splenic embolization can prevent variceal recurrence, bleeding, and death in cirrhosis patients with esophageal varices and thrombocytopenia.
Ohmoto
Kenji
K
Division of Hepatology, Department of Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan. ohmotok@med.kawasaki-m.ac.jp
Yamamoto
Shinichiro
S
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000517:prevention & control*; D004945:Esophagoscopy; D004947:Esophagus / Q000098:blood supply*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D006971:Hypersplenism / Q000401:mortality / Q000628:therapy*; D008026:Ligation; D008103:Liver Cirrhosis / Q000401:mortality / Q000628:therapy*; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011446:Prospective Studies; D055502:Secondary Prevention; D013154:Spleen / Q000098:blood supply*; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery