EUS-guided PSE in Combination With EUS-guided Treatment of Varices for Patients With Portal Hypertension
EUS-guided PSE in Combination With EUS-guided Treatment of Varices for Patients With Portal Hypertension
This study aims to evaluate the efficiency of EUS-guided combination therapy (EUS-guided PSE
 + EUS-guided treatment of varices) to EUS-guided treatment of varices alone in cirrhotic
 patients with portal hypertension who have developed gastroesophageal variceal hemorrhage and
 accompanied with hypersplenism.
Partial splenic embolization (PSE) was developed in the purpose of managing two common
 complications of portal hypertension including variceal bleeding and hypersplenism. The
 procedure is normally performed by clinicians engaged in interventional radiology via a
 transcatheter embolization method as the successful embolization of the selected splenic
 arteries results in devascularization of a focal lesion followed by splenic infarction and
 subsequently reducing the splenic contribution to the portal blood flow. Our previous case
 study suggests implanting coil in a branch of splenic artery under the endoscopic ultrasound
 (EUS) -guidance followed by the glue injection was an alternative PSE procedure to control
 hypersplenism. Recent advance has also heightened the therapeutic aspect of EUS in managing
 varices. We have established the novel approach to manage varices and hypersplenism at the
 same time by combining EUS-guided PSE and EUS-guided treatment of varices. This study aims to
 evaluate the efficiency of EUS-guided combination therapy (EUS-guided PSE + EUS-guided
 treatment of varices) to EUS-guided treatment of varices alone in cirrhotic patients with
 portal hypertension who have developed gastroesophageal variceal hemorrhage and accompanied
 with hypersplenism.
Inclusion Criteria:

 -  At the risk of gastroesophageal variceal hemorrhage; Acute gastroesophageal variceal
 hemorrhage; Hematemesis and/or melena resulted from gastroesophageal variceal
 hemorrhage of liver cirrhosis in the past.

 -  Hypersplenism is indicated by either abdominal ultrasound or CT image showing splenic
 enlargement or splenomegaly and CBC test showing deficiency of one or more blood cell
 lines.

 -  Consent form must be signed by patients or their guardians before entering the test.

 Exclusion Criteria:

 -  History of liver surgery or spleen surgery and liver cancer

 -  Coagulopathy (INR > 1.5) or having been taken oral anticoagulation agents such as
 aspirin, warfarin, etc. in the past week.

 -  Existence of gastrointestinal endoscopic therapy contraindication; Hemorrhagic shock
 has not be corrected; Hepatic encephalopathy; Moderate to severe ascites, Poor liver
 function (Child - Pugh class C).

 -  Severe cardiorespiratory dysfunction, including sinus bradycardia, bronchial asthma,
 chronic obstructive pulmonary disease, heart failure, and atrioventricular block

 -  Pregnant women and nursing mothers.

 -  Absence of informed consent