Long-Term Outcomes of Combined Endoscopic Ligation and Partial Splenic Artery Embolization for Gastroesophageal Variceal Bleeding in Patients With Cirrhosis: A Comparative Cohort Study
DOI:
https://doi.org/10.31149/ijimm.v4i9.2980Keywords:
cirrhosis, portal hypertension, gastroesophageal variceal bleeding, endoscopic ligation, partial splenic artery embolization, rebleeding, endovascular treatmentAbstract
Background: Gastroesophageal variceal bleeding is a major complication of cirrhosis and clinically significant portal hypertension and is associated with recurrent hemorrhage, hepatic decompensation, and death. Endoscopic ligation provides direct local treatment of esophageal varices but does not independently correct the portal hypertensive hemodynamic environment responsible for recurrent variceal formation and bleeding. Partial splenic artery embolization may reduce splenic arterial inflow and influence portal venous hemodynamics. This study evaluated the long-term outcomes of combined endoscopic ligation and partial splenic artery embolization compared with endoscopic ligation alone. Methods: A comparative clinical cohort comprising 171 patients with cirrhosis complicated by gastroesophageal variceal bleeding was evaluated. Patients underwent endoscopic ligation alone or combined endoscopic ligation and partial splenic artery embolization. The primary outcome was recurrent gastroesophageal variceal bleeding during long-term follow-up. Cumulative rebleeding rates at 1, 3, and 5 years were compared. Absolute risk reduction, relative risk, relative risk reduction, and approximate number needed to treat were calculated from the reported cumulative event rates. Results: Combined treatment was associated with consistently lower cumulative rebleeding. At 1 year, rebleeding occurred in 29.3% after endoscopic ligation alone and 8.5% after combined treatment (absolute risk reduction 20.8 percentage points; relative risk 0.29). At 3 years, rates were 41.4% and 18.6%, respectively (absolute risk reduction 22.8 percentage points; relative risk 0.45). At 5 years, rates were 50.0% and 25.4%, respectively (absolute risk reduction 24.6 percentage points; relative risk 0.51). The approximate number needed to treat ranged from 4 to 5 patients. Conclusions: Combined endoscopic ligation and partial splenic artery embolization was associated with lower long-term cumulative rebleeding than endoscopic ligation alone. The complementary strategy of direct variceal treatment combined with modification of splenic inflow may provide more durable control of recurrent gastroesophageal variceal bleeding. Prospective studies with complete patient-level data and formal time-to-event analyses are warranted.
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