Prevention of rebleeding in patients with portal hypertension and esophageal variceal bleeding

Abstract

Background: Despite the development of medicine esophageal variceal bleeding remain an urgent problem. The aim of the study was to evaluate the effectiveness of the use of embolization of the splenic artery in order to prevent portal bleeding. Methods and materials: The study included 96 patients, who had cirrhosis classes B and C (Child-Pugh) and esophageal variceal bleeding. Patients were divided into 2 groups: main group (n=71, 73.95%) – endoscopic ligating of bleeding and embolization of the splenic artery; comparison group (n=25, 26.05%) – only drug therapy. Results: In comparison group we stopped bleeding in 54 (76.1%) patients. 17 (23.9%) patients died. The duration of treatment was 10.1±2.4 days. In main group we stopped bleeding in 23 (92.0%) patients. 2 (8.0%) patients died. The duration of treatment was 6.5±2.7 days. A statistical analysis of mortality and duration of treatment revealed a significant difference (p<0.01) between the groups in both indicators. After splenic artery embolizationin all cases managed to achieve a reduction in blood flow of 60–80%. After 6 months among 54 patients in the comparison group, bleeding relapse occurred in 12 (22.2%) cases; in the main group – 2 (8.7%). Conclusion: Splenic artery embolization in patients after endoscopic hemostasis of variceal bleeding allows to reduce the pressure in the portal system, which in turn leads to a decrease in the frequency of bleeding recurrences.