Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation

• Published in: PloS one 2017-05, Vol.12 (5), p.e0177401-e0177401
• Main Authors: Buechter, Matthias, Kahraman, Alisan, Manka, Paul, Gerken, Guido, Dechêne, Alexander, Canbay, Ali, Wetter, Axel, Umutlu, Lale, Theysohn, Jens M
• Format: Article
• Language: English
• Subjects: Adenomatous polyposis coli; Adolescent; Adult; Aged; Angiography; Antibiotics; Arches; Argon; Argon plasma; Arteries; Arteriography; Ascites; Bilirubin; Biology and Life Sciences; Bleeding; Blood cells; Blood transfusion; Blood vessels; Cancer; Care and treatment; Chemotherapy; Coagulation; Complications and side effects; Computer programs; Dosage; Embolization, Therapeutic; Endoscopy; Endoscopy, Gastrointestinal; Error analysis; Esophagus; Failure; Female; Gastroenterology; Gastrointestinal hemorrhage; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - physiopathology; Gastrointestinal Hemorrhage - surgery; Health risks; Heart; Hemoglobin; Hemorrhage; Hepatic encephalopathy; Hepatology; Hospitals; Humans; Hypertension; Hypertension, Portal - complications; Hypertension, Portal - physiopathology; Hypertension, Portal - surgery; Influence; Laboratories; Liver cirrhosis; Liver diseases; Male; Management; Mathematical analysis; Medical imaging; Medicine and Health Sciences; Middle Aged; Morbidity; Mortality; Normality; Patient outcomes; Patients; pH effects; Platelets; Portal hypertension; Portasystemic Shunt, Transjugular Intrahepatic; Radiology; Retrospective Studies; Risk; Risk factors; Risk reduction; Spleen; Spleen - pathology; Spleen - physiopathology; Spleen - surgery; Statistical analysis; Subtraction; Surgery; Tips; Transplantation; Transplants & implants; Ultrasound; Upper Gastrointestinal Tract - pathology; Upper Gastrointestinal Tract - physiopathology; Upper Gastrointestinal Tract - surgery; Veins & arteries; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0177401

Upper gastrointestinal bleeding (UGIB) is a severe and life-threatening complication among patients with portal hypertension (PH). Covered transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice for patients with refractory or recurrent UGIB despite pharmacological and endoscopic therapy. In some patients, TIPS implantation is not possible due to co-morbidity or vascular disorders. Spleen embolization (SE) may be a promising alternative in this setting. We retrospectively analyzed 9 patients with PH-induced UGIB who underwent partial SE between 2012 and 2016. All patients met the following criteria: (i) upper gastrointestinal hemorrhage with primary or secondary failure of endoscopic interventions and (ii) TIPS implantation not possible. Each patient was followed for at least 6 months after embolization. Five patients (56%) suffered from cirrhotic PH, 4 patients (44%) from non-cirrhotic PH. UGIB occured in terms of refractory hemorrhage from gastric varices (3/9; 33%), hemorrhage from esophageal varices (3/9; 33%), and finally, hemorrhage from portal-hypertensive gastropathy (3/9; 33%). None of the patients treated with partial SE experienced re-bleeding episodes or required blood transfusions during a total follow-up time of 159 months, including both patients with cirrhotic- and non-cirrhotic PH. Partial SE, as a minimally invasive intervention with low procedure-associated complications, may be a valuable alternative for patients with recurrent PH-induced UGIB refractory to standard therapy.