Comparative analysis of secondary prophylaxis strategies for esophageal variceal bleeding in clinically manifest portal hypertension: a 12-year single-center study

Authors

DOI:

https://doi.org/10.15574/PS.2025.4(89).3240

Keywords:

portal hypertension, esophageal varices, variceal bleeding, secondary prophylaxis, partial splenic artery embolization, endoscopic injection sclerotherapy

Abstract

Recurrent variceal bleeding remains a leading cause of mortality in patients with portal hypertension (PH). Standard secondary prophylaxis strategies (SP), including non-selective β-blockers (NSBB) and endoscopic injection sclerotherapy (EIS), demonstrate suboptimal anti-recurrence efficacy.

Aim - to determine the optimal SP method for esophageal variceal bleeding (EVB) by comparing long-term outcomes of partial splenic artery embolization (PSE) versus NSBB and EIS-based strategies.

Materials and methods. This prospective and retrospective study included 514 patients who survived at least one EVB episode. SP efficacy was analyzed in three groups: NSBB monotherapy (n=243), EIS+NSBB (n=151), and PSE+NSBB (n=120). The efficacy evaluation criteria were survival and EVB recurrence rates within 12 months.

Results. During the 12-month follow-up, survival was significantly higher in the PSE group (0.87) than in the NSBB (0.73) and EIS (0.64) groups (p < 0.001), respectively. Recurrence-free status at one year was achieved in 56.2% of PSE patients, versus 35.0% in EIS and 24.3% in NSBB. All-cause mortality was lowest after PSE (13.3%) and highest in the EIS group (37.1%).

Conclusions. PSE provides significantly higher SP efficacy compared to standard strategies, offering an effective minimally invasive treatment for high-risk patients with clinically significant PH.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study approved by the Local Ethics Committee. Informed consent was obtained from all patients. The authors declare no conflict of interest.

References

Bosch J, Groszmann RJ, Shah VH. (2015). Evolution in the understanding of the pathophysiological basis of portal hypertension: How changes in paradigm are leading to successful new treatments. J Hepatol. 62; 1 Suppl: S121-S130. https://doi.org/10.1016/j.jhep.2015.01.003; PMid:25920081 PMCid:PMC4519833

D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol.;44(1):217-231. https://doi.org/10.1016/j.jhep.2005.10.013; PMid:16298014 PMCid:PMC9202807

De Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C et al. (2022). Expanding consensus in portal hypertension: Report of the Baveno VII consensus workshop: Personalizing care for portal hypertension. J Hepatol. 76(4): 959-974. https://doi.org/10.1016/j.jhep.2021.12.022; PMid:35120736 PMCid:PMC11090185

Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. (2017). Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 65(1): 310-335. https://doi.org/10.1002/hep.28906; PMid:27786365

Graham DY, Smith JL. (1981). The course of patients after variceal hemorrhage. Gastroenterology. 80(4): 800-809. https://doi.org/10.1016/0016-5085(81)90144-X; PMid:6970703

Helaly AZ, Al-Warraky MS, El-Azab GI, Kohla MA, Abdelaal EE. (2015). Portal and splanchnic hemodynamics after partial splenic embolization in cirrhotic patients with hypersplenism. APMIS. 123(12): 1032-1039. https://doi.org/10.1111/apm.12470; PMid:26547369

Kaplan DE, Ripoll C, Thiele M, Fortune BE, Simonetto DA, Garcia-Tsao G et al. (2024). AASLD Practice Guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology. 79(5): 1180-1211. https://doi.org/10.1097/HEP.0000000000000647; PMid:37870298

Koconis KG, Singh H, Soares G. (2007). Partial splenic embolization in the treatment of patients with portal hypertension: a review of the english language literature. J Vasc Interv Radiol. 18(4): 463-481. https://doi.org/10.1016/j.jvir.2006.12.734; PMid:17446537

Saeki M, Okubo H, Takasaki Y, Nakadera E, Fukuo Y, Fukada H et al. (2023). The Impact of Partial Splenic Embolization on Portal Hypertensive Gastropathy in Cirrhotic Patients with Portal Hypertension. J Clin Med. 12(7): 2662. https://doi.org/10.3390/jcm12072662; PMid:37048744 PMCid:PMC10094775

Spigos DG, Jonasson O, Mozes M, Capek V. (1979). Partial splenic embolization in the treatment of hypersplenism. AJR Am J Roentgenol. 132(5): 777-782. https://doi.org/10.2214/ajr.132.5.777; PMid:107745

Villanueva C, Albillos A, Genescà J, Garcia-Pagan JC, Calleja JL, Aracil C et al. (2019). Beta blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 393(10181): 1597-1608. https://doi.org/10.1016/S0140-6736(18)31875-0; PMid:30910320 PMCid:PMC9202807

Yin X, Gu L, Zhang M, Yin Q, Xiao J, Wang Y et al. (2022). Covered TIPS Procedure-Related Major Complications: Incidence, Management and Outcome From a Single Center. Front Med (Lausanne). 9: 834106. https://doi.org/10.3389/fmed.2022.834106; PMid:35602500 PMCid:PMC9116508

Younossi ZM, de Avila L, Racila A, Nader F, Paik J, Henry L et al. (2025). Prevalence and predictors of cirrhosis and portal hypertension in the United States. Hepatology. 82(5): 1229-1240. https://doi.org/10.1097/HEP.0000000000001243; PMid:39879587

Zhu K, Meng X, Qian J, Huang M, Li Z, Guan S et al. (2009). Partial splenic embolization for hypersplenism in cirrhosis: a long-term outcome in 62 patients. Dig Liver Dis. 41(6): 411-416. https://doi.org/10.1016/j.dld.2008.10.005; PMid:19070555

Downloads

Published

2025-12-28

Issue

No. 4(89) (2025): Paediatric surgery (Ukraine)

Section

Original articles. Thoracic surgery

License

Copyright (c) 2025 Paediatric Surgery (Ukraine)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).

Authors transfer the copyright to the Journal “PAEDIATRIC SURGERY.UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.

Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.

The use of published materials for commercial purposes is strongly prohibited.