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
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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: July 02, 2021
Accepted:
June 22,
2021
Received:
March 19,
2021
Footnotes
DISCLOSURE: All authors disclosed no financial relationships. Research support for this study was provided in part by grants from the National Natural Science Foundation of China (81974077) received by Dr Qian, and Funding of Health and Family Planning Commission of Hubei province (WJ2019M133) received by Dr Zhen-gang Zhang.
DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure that the language of the study questionnaires reflected inclusion.
Identification
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© 2022 by the American Society for Gastrointestinal Endoscopy
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- PreviewThe past decade has seen the development and evolution of Endo-hepatology, an exciting field that represents the intersection between endoscopy and liver disease.1 The refinement of diagnostic tools including EUS-guided liver biopsy, portal pressure gradient measurement, and shear wave elastography as well as therapeutic interventions for gastroesophageal varices have empowered endoscopists to partner with hepatologists to provide comprehensive care for patients with complex liver disease.
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