Impact of combination partial splenic embolization and endoscopic variceal ligation therapy in cirrhosis patients with esophageal varices and thrombocytopenia *
Purpose:We investigated the impact of different treatments on the prognosis of cirrhosis patients with esophageal varices and thrombocytopenia. Patients and Methods:This retrospective study involved 90 cirrhosis patients with esophageal varices and thrombocytopenia（platelet count＜50,000/mm3）. In 48 patients, partial splenic embolization（PSE）and endoscopic variceal ligation（EVL）were performed, while EVL alone was done in 42 patients. The two groups were well matched with respect to clinical characteristics. PSE was performed using the Seldinger method and small amounts of embolic material were injected until there was a 60％to 80％reduction in splenic blood flow. EVL was performed using a standard endoscope with a pneumoactived single ligator and an overtube and was repeated at weekly intervals until complete eradication of the varices was achieved. In patients with large varices, prophylactic EVL was performed even if the varices were not bleeding. PSE was done two weeks before EVL and vasoactive drugs or non-selective beta-blockers were not given. In patients with active variceal bleeding, emergency EVL was performed first to achieve hemostasis, and PSE was done two weeks later. Primary endpoints assessed during the follow-up period included the recurrence of varices, progression to variceal bleeding, and death. Results:Comparison between combined treatment and variceal ligation alone by multivariate analysis showed a hazard ratio of 0.42（95％CI［0.21-0.88］）for the recurrence of varices（P＝0.02）, 0.18（95％CI［0.04-0.68］）for progression to variceal bleeding（P＝0.01）, and 0.29（95％CI［0.11-0.69］）for death（P＝0.03）. Conclusions:These results suggest that the combination of PSE and EVL can prevent the recurrence of varices, progression to variceal bleeding, and death in cirrhosis patients with esophageal varices and thrombocytopenia. (Accepted on December 19，2007)
