Partial Splenic embolization combined with endoscopic variceal ligation in variceal rebleeding prevention among liver cirrhosis patients complicated with hypersplenism, thrombocytopenia, and esophagogastric variceal hemorrhage: a prospective observational study.

BACKGROUND: Patients with liver cirrhosis often suffer from complications such as splenomegaly, thrombocytopenia, and esophagogastric variceal hemorrhage, necessitating effective preventive measures. This study aimed to investigate the outcome of partial splenic embolization (PSE) combined with endoscopic variceal ligation (EVL) in variceal rebleeding prevention among liver cirrhosis patients complicated with hypersplenism, thrombocytopenia, and esophagogastric variceal hemorrhage. METHODS: This prospective observational study enrolled liver cirrhosis patients complicated with hypersplenism, thrombocytopenia, and esophagogastric variceal hemorrhage who received PSE combined with EVL (PSE & EVL) or EVL alone based on informed patient's choice at the Affiliated Wenshan Hospital between November 2019 and October 2021. The primary outcome was the variceal rebleeding rate at postoperative 2 years, secondary outcomes included changes in platelet, white blood cell (WBC) counts and complications. RESULTS: The baseline characteristics between patients who received PSE & EVL (n = 26, aged 54.12 ± 9.39, 21 males) and EVL alone (n = 40, aged 52.08 ± 11.64, 33 males) were comparable (all P > 0.05). Two years after surgery, patients received PSE & EVL were more likely to have lower rate (23.3% vs. 53.5%, P = 0.020) and risk of variceal rebleeding [HR (hazard ratio) = 0.36, 95% confidence interval (CI): 0.17-0.77, P = 0.020] compared to those received EVL alone. The platelet (60.58 ± 13.55 vs. 48.84 ± 11.41, P = 0.007) and WBC (5.12 ± 0.91 vs. 4.18 ± 0.92, P = 0.002) levels in patients received PSE + EVL at postoperative 2 years were significantly higher than those received EVL alone, while the occurrence of postoperative complications, such as abdominal pain, abdominal distension, nausea, vomiting, postoperative fever, and palpitations between patients who received PSE & EVL and EVL alone were similar (all P > 0.05). CONCLUSION: Combining PSE with EVL may reduce variceal rebleeding risk and boosts postoperative platelet and WBC counts without increasing complications. This study highlights the significance of this combined therapy in managing liver cirrhosis complications, offering valuable guidance for clinical practice.