Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding

Wei-Li Qi; Jun Wen; Tian-Fu Wen; Wei Peng; Xiao-Yun Zhang; Jun-Yi Shen; Xiao Li; Chuan Li

doi:10.4240/wjgs.v15.i8.1641

Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding

World J Gastrointest Surg. 2023 Aug 27;15(8):1641-1651. doi: 10.4240/wjgs.v15.i8.1641.

Authors

Wei-Li Qi¹, Jun Wen^{1

2}, Tian-Fu Wen¹, Wei Peng¹, Xiao-Yun Zhang¹, Jun-Yi Shen¹, Xiao Li^{3

4}, Chuan Li⁵

Affiliations

¹ Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
² Section for HepatoPancreatoBiliary Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610041, Sichuan Province, China.
³ Department of Interventional Therapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
⁴ Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100000, China.
⁵ Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. lichuan@scu.edu.cn.

Abstract

Background: Portal hypertension combined with esophagogastric variceal bleeding (EGVB) is a serious complication in patients with hepatitis B virus (HBV)-related cirrhosis in China. Splenectomy plus pericardial devascularization (SPD) and transjugular intrahepatic portosystemic shunt (TIPS) are effective treatments for EGVB. However, a comparison of the effectiveness and safety of those methods is lacking.

Aim: To compare the prognosis after SPD vs TIPS for acute EGVB after failure of endoscopic therapy or secondary prophylaxis of variceal rebleeding (VRB) in patients with HBV-related cirrhosis combined with portal hypertension.

Methods: This retrospective cohort study included 318 patients with HBV-related cirrhosis and EGVB who underwent SPD or TIPS at West China Hospital of Sichuan University during 2009-2013. Propensity score-matched analysis (PSM), the Kaplan-Meier method, and multivariate Cox regression analysis were used to compare overall survival, VRB rate, liver function abnormality rate, and hepatocellular carcinoma (HCC) incidence between the two patient groups.

Results: The median age was 45.0 years (n = 318; 226 (71.1%) males). During a median follow-up duration of 43.0 mo, 18 (11.1%) and 33 (21.2%) patients died in the SPD and TIPS groups, respectively. After PSM, SPD was significantly associated with better overall survival (OS) (P = 0.01), lower rates of abnormal liver function (P < 0.001), and a lower incidence of HCC (P = 0.02) than TIPS. The VRB rate did not differ significantly between the two groups (P = 0.09).

Conclusion: Compared with TIPS, SPD is associated with higher postoperative OS rates, lower rates of abnormal liver function and HCC, and better quality of survival as acute EGVB treatment after failed endoscopic therapy or as secondary prophylaxis of VRB in patients with HBV-related cirrhosis combined with portal hypertension. There is no significant between-group difference in VRB rates.

Keywords: Esophagogastric variceal bleeding; Liver cirrhosis; Pericardial devascularization; Portal hypertension; Splenectomy; Transjugular intrahepatic portosystemic shunt.