Therapeutic effects of endoscopic variceal ligation combined with partial splenic embolization for portal hypertension.
OBJECTIVE
To evaluate the feasibility of a new strategy of endoscopic variceal ligation combined with partial splenic embolization (EVL-PSE) for patients with cirrhosis and portal hypertension.


METHODS
From May 1999 to May 2002, 41 cases with cirrhosis and portal hypertension underwent EVL-PSE. Hemodynamics of the main portal vein (MPV), the left gastric vein (LGV) and azygos vein, including maximum velocity, flow rate and vein diameter, were assessed by Doppler ultrasonography.


RESULTS
One case died from pulmonary artery embolism. One case complicated with splenic abscess was successfully managed by laparotomy. The esophageal varices and hypersplenism were well controlled after EVL-PSE in other patients. After EVL-PSE, the flow rate and velocity of MPV was significantly reduced (P<0.05), as well as the flow rate of the LGV and azygos vein. During the follow-up, no recurrent bleeding was found.


CONCLUSIONS
Being more convenient and less invasive, EVL-PSE is hopeful to be a proper intervention strategy for portal hypertensive patients with impaired hepatic function or those intolerant to shunting or devascularization surgery.
Xu
Rui-Yun
RY
Department of General Surgery, The Third Affiliated Hospital, Sun-Yet-San University, Guangzhou 510630, Guangdong Province, China. xuruiyun@yahoo.com
Liu
Bo
B
Lin
Nan
N
D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000628:therapy*; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000098:blood supply*