학술논문
The role and evolution of partial splenic embolization over three decades: A multicentric retrospective single cohort study of 90 patients from French nationwide experience.
Document Type
Academic Journal
Author
Leideck P; Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France.; Nkontchou G; Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Service d'Hépato-Gastroentérologie, Bobigny, France.; Elkrief L; CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France.; Erard D; Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France.; d'Alteroche L; CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France.; Radenne S; Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France.; Billioud C; Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France.; Meszaros M; CHU Saint Eloi, Département d'Hépatologie et Transplantation Hépatique, Montpellier, France.; Regnault D; CHU Tours, Hôpital Trousseau, Service d'Hépato-Gastroentérologie, Tours, France.; Pageaux GP; CHU Saint Eloi, Département d'Hépatologie et Transplantation Hépatique, Montpellier, France.; Hilleret MN; CHU Grenoble-Alpes, Service d'Hépato-Gastroentérologie, La Tronche, France.; Tripon S; CHRU Hautepierre, Service d'Hépato-Gastroentérologie, Strasbourg, France.; Guillaud O; Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France; Clinique de la Sauvegarde, Ramsay Générale de Santé, Lyon, France.; Ollivier-Hourmand I; CHU Caen Normandie, Service d'Hépato-Gastroentérologie, Caen, France.; Ganne-Carrié N; Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Service d'Hépato-Gastroentérologie, Bobigny, France.; Dumortier J; Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, 03, Lyon CEDEX 69437, France. Electronic address: jerome.dumortier@chu-lyon.fr.
Source
Publisher: Elsevier Masson Country of Publication: France NLM ID: 101553659 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2210-741X (Electronic) Linking ISSN: 22107401 NLM ISO Abbreviation: Clin Res Hepatol Gastroenterol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Partial splenic embolization (PSE) has been proposed to treat the consequences of hypersplenism in the context of portal hypertension, especially thrombocytopenia. However, a high morbidity/mortality rate has made this technique unpopular. We conducted a multicenter retrospective nationwide French study to reevaluate efficacy and tolerance.
Methods: All consecutive patients who underwent PSE for hypersplenism and portal hypertension in 7 tertiary liver centers between 1998 and 2023 were included.
Results: The study population consisted of 91 procedures in 90 patients, with a median age of 55.5 years [range 18-83]. The main cause of portal hypertension was cirrhosis (84.6 %). The main indications for PSE were (1) an indication of medical treatment or radiological/surgical procedure in the context a severe thrombocytopenia (59.3 %), (2) a chronic hemorrhagic disorder associated with a severe thrombocytopenia (18.7 %), and (3) a chronic pain associated with a major splenomegaly (9.9 %). PSE was associated with a transjugular intrahepatic portosystemic shunt in 20 cases. Median follow-up after PSE was 41.9 months [0.5-270.5]. Platelet count increased from a median of 48.0 G/L [IQR 37.0; 60.0] to 100.0 G/L [75.0; 148]. Forty-eight patients (52.7 %) had complications after PSE; 25 cases were considered severe (including 7 deaths). A Child-Pugh B-C score (p < 0.02) was significantly associated with all complications, a history of portal vein thrombosis (p < 0.01), and the absence of prophylactic antibiotherapy (p < 0.05) with severe complications.
Conclusion: Our results strongly confirm that PSE is very effective, for a long time, although a quarter of the patients experienced severe complications. Improved patient selection (exclusion of patients with portal vein thrombosis and decompensated cirrhosis) and systematic prophylactic antibiotherapy could reduce morbidity and early mortality in the future.
Competing Interests: Declaration of competing interest The authors have no conflict of interest to disclose.
(Copyright © 2024. Published by Elsevier Masson SAS.)
Methods: All consecutive patients who underwent PSE for hypersplenism and portal hypertension in 7 tertiary liver centers between 1998 and 2023 were included.
Results: The study population consisted of 91 procedures in 90 patients, with a median age of 55.5 years [range 18-83]. The main cause of portal hypertension was cirrhosis (84.6 %). The main indications for PSE were (1) an indication of medical treatment or radiological/surgical procedure in the context a severe thrombocytopenia (59.3 %), (2) a chronic hemorrhagic disorder associated with a severe thrombocytopenia (18.7 %), and (3) a chronic pain associated with a major splenomegaly (9.9 %). PSE was associated with a transjugular intrahepatic portosystemic shunt in 20 cases. Median follow-up after PSE was 41.9 months [0.5-270.5]. Platelet count increased from a median of 48.0 G/L [IQR 37.0; 60.0] to 100.0 G/L [75.0; 148]. Forty-eight patients (52.7 %) had complications after PSE; 25 cases were considered severe (including 7 deaths). A Child-Pugh B-C score (p < 0.02) was significantly associated with all complications, a history of portal vein thrombosis (p < 0.01), and the absence of prophylactic antibiotherapy (p < 0.05) with severe complications.
Conclusion: Our results strongly confirm that PSE is very effective, for a long time, although a quarter of the patients experienced severe complications. Improved patient selection (exclusion of patients with portal vein thrombosis and decompensated cirrhosis) and systematic prophylactic antibiotherapy could reduce morbidity and early mortality in the future.
Competing Interests: Declaration of competing interest The authors have no conflict of interest to disclose.
(Copyright © 2024. Published by Elsevier Masson SAS.)