A novel therapeutic strategy for esophageal varices using endoscopic treatment combined with splenic artery embolization according to the Child-Pugh classification
Autoři:
Tsuyoshi Ishikawa aff001; Ryo Sasaki aff001; Tatsuro Nishimura aff001; Yuki Aibe aff001; Issei Saeki aff001; Takuya Iwamoto aff001; Isao Hidaka aff001; Taro Takami aff001; Isao Sakaida aff001
Působiště autorů:
Yamaguchi University Graduate School of Medicine, Department of Gastroenterology & Hepatology, Ube-Yamaguchi, Japan
aff001
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0223153
Souhrn
Variceal hemorrhage may cause high rebleeding and mortality rates. Preventing the first episode of variceal bleeding is mandatory in patients with high-risk esophageal varices (EV). This study aimed to identify factors that predict the recurrence of EV after endoscopic treatment (ET), and to develop a reasonable therapeutic strategy for EV in cirrhosis. From January 2012 to December 2014, 45 patients with cirrhosis and high-risk EV underwent ET, including sclerotherapy and/or ligation. Statistical analyses identified factors associated with the recurrence of EV after ET, and the Kaplan-Meier method determined the cumulative variceal recurrence rates. The 1-, 2-, and 3-year cumulative posttreatment recurrence rates for EV were 13.3%, 29.5%, and 32.2%, respectively. No significant differences were evident between the patients with and without variceal recurrences at 1-year posttreatment. The multivariate regression analyses identified a history of partial splenic embolization (PSE) and the pretreatment Child-Pugh classification as independent predictors of variceal recurrences at 2 years (p < 0.05) and 3 years (p < 0.05) posttreatment. While EV did not recur after ET and splenic artery embolization in cases with Child-Pugh class A, the overall posttreatment variceal recurrence rates were 0% and 66.7% when PSE was performed before and after ET, respectively, in those with Child-Pugh class B or C. Splenic artery embolization significantly reduced the hepatic venous pressure gradient and markedly lowered the Child-Pugh score in 15 patients. Adjunctive PSE and pretreatment Child-Pugh class A could be independently associated with reduced cumulative recurrence rates of EV post-ET. From the perspectives of portal hemodynamics and hepatic function, splenic artery embolization before or after ET could prevent posttreatment variceal recurrence in patients with Child-Pugh class A, and PSE before ET could achieve the long-term eradication of EV following ET in those with Child-Pugh class B or C.
Klíčová slova:
Arteries – Cirrhosis – Hemodynamics – Endoscopy – Platelets – Portal hypertension – Veins
Zdroje
1. Lo GH. Endoscopic treatments for portal hypertension. Hepatol Int. 2018;12(Suppl 1): 91–101. doi: 10.1007/s12072-017-9828-8 29110128
2. Dhiman RK, Choudhuri G, Saraswat VA, Agarwal DK, Naik SR. Role of paraoesophageal collaterals and perforating veins on outcome of endoscopic sclerotherapy for oesophageal varices: an endosonographic study. Gut. 1996;38: 759–764. doi: 10.1136/gut.38.5.759 8707125
3. Lo GH, Lai KH, Cheng JS, Huang RL, Wang SJ, Chiang HT. Prevalence of paraesophageal varices and gastric varices in patients achieving variceal obliteration by banding ligation and by injection sclerotherapy. Gastrointest Endosc. 1999;49: 428–436. doi: 10.1016/s0016-5107(99)70038-6 10202054
4. Dhiman RK, Chawla YK. Is the technique of endoscopic sclerotherapy and ligation (ESL) optimum? Gastrointest Endosc. 2000;51: 639–640. doi: 10.1016/s0016-5107(00)70319-1 10805868
5. Dhiman RK, Chawla YK. A new technique of combined endoscopic sclerotherapy and ligation for variceal bleeding. World J Gastroenterol. 2003;9: 1090–1093. doi: 10.3748/wjg.v9.i5.1090 12717863
6. Seno H, Konishi Y, Wada M, Fukui H, Okazaki K, Chiba T. Endoscopic ultrasonograph evaluation of vascular structures in the gastric cardia predicts esophageal variceal recurrence following endoscopic treatment. J Gastroenterol Hepatol. 2006;21: 227–231. doi: 10.1111/j.1440-1746.2006.04129.x 16460478
7. Chawla YK, Dilawari JB, Kaur U. Variceal sclerotherapy in cirrhosis. Indian J Gastroenterol. 1988;7: 215–217. 3263322
8. Taniai N, Onda M, Tajiri T, Toba M, Yoshida H. Endoscopic variceal ligation (EVL) combined with partial splenic embolization (PSE). Hepatogastroenterology. 1999;46: 2849–2853. 10576359
9. Svoboda P, Kantorová I, Ochmann J, Kozumplík L, Marsová J. A prospective randomized controlled trial of sclerotherapy vs ligation in the prophylactic treatment of high-risk esophageal varices. Surg Endosc. 1999;13: 580–584. doi: 10.1007/s004649901045 10347295
10. Bohnacker S, Sriram PV, Soehendra N. The role of endoscopic therapy in the treatment of bleeding varices. Baillieres Best Pract Res Clin Gastroenterol. 2000;14: 477–494. doi: 10.1053/bega.2000.0092 10952810
11. Bañares R, Albillos A, Rincón D, Alonso S, González M, Ruiz-del-Arbol L, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology. 2002;35: 609–615. doi: 10.1053/jhep.2002.31354 11870374
12. Taniai N, Onda M, Tajiri T, Yoshida H, Mamada Y. Combined endoscopic and radiologic intervention to treat esophageal varices. Hepatogastroenterology. 2002;49: 984–988. 12143259
13. Sarin SK, Wadhawan M, Agarwal SR, Tyagi P, Sharma BC. Endoscopic variceal ligation plus propranolol versus endoscopic variceal ligation alone in primary prophylaxis of variceal bleeding. Am J Gastroenterol. 2005;100: 797–804. 15784021
14. Lo GH, Chen WC, Wang HM, Lee CC. Controlled trial of ligation plus nadolol versus nadolol alone for the prevention of first variceal bleeding. Hepatology. 2010;52: 230–237. doi: 10.1002/hep.23617 20578138
15. The Liver Cancer Study Group of Japan. The General Rules for the Clinical and Pathological Study of Primary Liver Cancer. 6th ed. Tokyo: Kanehara; 2015.
16. The Japan Society for Portal Hypertension. The General Rules for Study of Portal Hypertension. 3rd ed. Tokyo: Kanehara; 2013.
17. Shimizu H, Takatsuka K, Yoshida A, Yoshimatsu E, Matsui K, Iwabuchi S. Partial splenic embolization reverses insulin resistance in patients with liver cirrhosis. Intern Med. 2009;48: 747–751. doi: 10.2169/internalmedicine.48.1649 19443968
18. Ishikawa T, Shiratsuki S, Matsuda T, Iwamoto T, Takami T, Uchida K, et al. Occlusion of portosystemic shunts improves hyperinsulinemia due to insulin resistance in cirrhotic patients with portal hypertension. J Gastroenterol. 2014;49: 1333–1341. doi: 10.1007/s00535-013-0893-z 24096983
19. Ishikawa T, Aibe Y, Matsuda T, Iwamoto T, Takami T, Sakaida I. Plasma Glucose Level Is Predictive of Serum Ammonia Level After Retrograde Occlusion of Portosystemic Shunts. AJR Am J Roentgenol. 2017;209: W169–W176. doi: 10.2214/AJR.16.17307 28657848
20. Xu RY, Liu B, Lin N. Therapeutic effects of endoscopic variceal ligation combined with partial splenic embolization for portal hypertension. World J Gastroenterol. 2004;10: 1072–1074. doi: 10.3748/wjg.v10.i7.1072 15052697
21. Ohmoto K, Yoshioka N, Tomiyama Y, Shibata N, Takesue M, Yoshida K, et al. Improved prognosis of cirrhosis patients with esophageal varices and thrombocytopenia treated by endoscopic variceal ligation plus partial splenic embolization. Dig Dis Sci. 2006;51: 352–358. doi: 10.1007/s10620-006-3137-8 16534680
22. Spigos DG, Jonasson O, Mozes M, Capek V. Partial splenic embolization in the treatment of hypersplenism. AJR Am J Roentgenol. 1979;132: 777–782. doi: 10.2214/ajr.132.5.777 107745
23. Pålsson B, Verbaan H. Partial splenic embolization as pretreatment for antiviral therapy in hepatitis C virus infection. Eur J Gastroenterol Hepatol. 2005;17: 1153–1155. doi: 10.1097/00042737-200511000-00001 16215425
24. Madoff DC, Denys A, Wallace MJ, Murthy R, Gupta S, Pillsbury EP, et al. Splenic arterial interventions: anatomy, indications, technical considerations, and potential complications. Radiographics. 2005;25 Suppl 1: S191–S211.
25. Chikamori F, Kuniyoshi N, Kawashima T, Takase Y. Short-term portal hemodynamic effects of partial splenic embolization for hypersplenism. Hepatogastroenterology. 2007;54: 1847–1849. 18019732
26. Mukaiya M, Hirata K, Yamashiro K, Katsuramaki T, Kimura H, Denno R. Changes in portal hemodynamics and hepatic function after partial splenic embolization (PSE) and percutaneous transhepatic obliteration (PTO). Cancer Chemother Pharmacol. 1994;33 Suppl: S37–S41.
27. Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005;353: 2254–2261. doi: 10.1056/NEJMoa044456 16306522
28. D'Amico G, Garcia-Pagan JC, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology. 2006;131: 1611–1624. doi: 10.1053/j.gastro.2006.09.013 17101332
29. Miyaaki H, Ichikawa T, Taura N, Miuma S, Isomoto H, Nakao K. Endoscopic management of esophagogastric varices in Japan. Ann Transl Med. 2014;2: 42. doi: 10.3978/j.issn.2305-5839.2014.05.02 25333017
30. Ali SM, Wu S, Xu H, Liu H, Hao J, Qin C. A Prospective Study of Endoscopic Injection Sclerotherapy and Endoscopic Variceal Ligation in the Treatment of Esophageal Varices. J Laparoendosc Adv Surg Tech A. 2017;27: 333–341. doi: 10.1089/lap.2016.0436 28221819
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