Partial splenic embolization used for rescue treatment for variceal bleeding as a safe and efficient procedure – experience at a university medical center

Background Partial splenic embolization (PSE) is a non-surgical procedure, currently used to treat different clinical diseases and conditions such as portal hypertension and esophageal and gastric variceal hemorrhage due to portal hypertension and/or splenic vein thrombosis. We evaluated the safety and efficacy of PSE in patients with variceal bleeding due to portal hypertension.

Methods Within seven years (2015-2022), twenty-five patients with esophageal varices grade III-IV or gastric fundal varices underwent PSE. All patients had significant portal hypertension due to different underlying diseases. In two cases patients with hypersplenism and cytopenia PSE was preferred despite technical feasibility of TIPS placement.

Results All patients with acute or recurrent esophageal and gastric fundal variceal bleeding were successfully treated with PSE as rescue therapy. In twelve cases with uncontrollable variceal bleeding PSE was performed under emergency conditions. Control gastroscopy revealed significant regression of esophageal and gastric varices, classified as Grade II or lower after PSE. During the follow up period no further bleeding episodes occurred. Platelet count increased starting from day one after PSE. After one week, thrombocyte levels improved significantly. After six months, thrombocytes maintained at significantly higher levels. Fever and abdominal pain were side effects of the procedure. Severe complications were not observed.

Conclusion PSE is a successful salvage therapy for patients with esophageal and/or gastric varices in which endoscopic treatment options or placement of a transjugular intrahepatic portosystemic shunt are not promising or technically not feasible. Even for patients with fulminant variceal bleeding PSE is an effective tool in emergency treatment.

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Artikel online veröffentlicht:
18. Januar 2023