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Hemodynamic effect through a novel endoscopic intervention in management of varices and hypersplenism (with video)

  • Author Footnotes
    ∗ Drs Zhang, Li, and Y. Yang contributed equally to this article.
    Zhen-gang Zhang
    Footnotes
    ∗ Drs Zhang, Li, and Y. Yang contributed equally to this article.
    Affiliations
    The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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  • Author Footnotes
    ∗ Drs Zhang, Li, and Y. Yang contributed equally to this article.
    Zhen Li
    Footnotes
    ∗ Drs Zhang, Li, and Y. Yang contributed equally to this article.
    Affiliations
    Department of Radiology at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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  • Author Footnotes
    ∗ Drs Zhang, Li, and Y. Yang contributed equally to this article.
    Yang Yang
    Footnotes
    ∗ Drs Zhang, Li, and Y. Yang contributed equally to this article.
    Affiliations
    Department of Radiology at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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  • Bin Cheng
    Affiliations
    The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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  • Wei Yan
    Affiliations
    The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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  • Yue Yuan
    Affiliations
    The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China

    Hubei Key Laboratory of Hepato-Pancreato-Biliary Disease, at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST) Wuhan, China
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  • Min Chen
    Affiliations
    The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China

    Hubei Key Laboratory of Hepato-Pancreato-Biliary Disease, at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST) Wuhan, China
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  • Wei Hou
    Affiliations
    The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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  • Min Yang
    Affiliations
    The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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  • Qian Chen
    Correspondence
    Reprint requests: Professor Qian Chen, Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, HUST, 1095 Jie Fang Ave, Wuhan 430030, PR China.
    Affiliations
    The Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China

    Hubei Key Laboratory of Hepato-Pancreato-Biliary Disease, at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST) Wuhan, China
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Zhang, Li, and Y. Yang contributed equally to this article.

      Background and Aims

      We previously reported a new and combined EUS-guided intervention in a patient with portal hypertension, consisting of obliteration of varices and partial splenic embolization (PSE). Performing PSE is known to diminish the increase in portal venous pressure after endoscopic intervention for varices. The aim of this study was to use multidetector CT portal venography to evaluate the anatomy of esophagogastric varices (EGV) and the impact on hemodynamics of portosystemic collaterals shortly after the concomitant procedures.

      Methods

      From October 2019 to December 2020, 5 patients with cirrhosis and with clinically significant portal hypertension who had variceal bleeding history and hypersplenism were treated with combined endoscopic obliteration for varices and EUS-guided PSE. Multidetector CT portal venography was applied to assess the anatomic drainage patterns of the EGV, diameters of feeders and drainage vessels, and splenic embolization rate.

      Results

      Within 5 days after concomitant endoscopic interventions, we observed decreased mean diameters of the left gastric vein, short gastric vein, and azygos vein as .3 mm, 1.0 mm, and 5.2 mm compared with 3.11 mm, 7.1 mm, and 5.4 mm before the procedures, respectively. Patients showed increased white blood cells (mean count of 2.7 × 109/L before vs 5.8 × 109/L after) and platelets (mean count of 52.8 × 109/L before vs 95.8 × 109/L after). The mean splenic embolization rate was 64.5% (range, 28.8%-84.6%).

      Conclusions

      Our experience may illustrate an alternative technique of combining EUS-guided PSE with endoscopic therapy of varices to treat patients with portal hypertension.

      Graphical abstract

      Abbreviations:

      AZV (azygos vein), CTPV (CT portal venography), CYA (cyanoacrylate), EGV (esophagogastric varices), GFV (gastric fundal varices), GRS (gastrorenal shunt), LGV (left gastric vein), LIPV (left inferior phrenic vein), PSE (partial splenic embolization), PV (portal vein), SGV (short gastric vein)
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