Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2016; 22(43): 9623-9630
Published online Nov 21, 2016. doi: 10.3748/wjg.v22.i43.9623
Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension
Omer Ozturk, Gonca Eldem, Bora Peynircioglu, Taylan Kav, Aysegul Görmez, Barbaros Erhan Cil, Ferhun Balkancı, Cenk Sokmensuer, Yusuf Bayraktar
Omer Ozturk, Taylan Kav, Yusuf Bayraktar, Department of Gastroenterology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
Gonca Eldem, Barbaros Erhan Cil, Ferhun Balkancı, Bora Peynırcıoglu, Aysegül Görmez, Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
Cenk Sokmensuer, Department of Pathology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
Author contributions: Peynircioglu B and Bayraktar Y designed the study; Ozturk O and Kav T wrote the manuscript and performed the statistical analysis; Eldem G and Görmez A performed the embolization procedure; Sokmensuer C evaluated the pathology; Cil BE and Balkancı F revised the manuscript.
Institutional review board statement: All experiments were in compliance with the ethics of the Institutional Review Board of Hacettepe University Medical Center.
Informed consent statement: Oral informed consent was obtained from all patients before taking part in the questionnaire.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Data sharing statement: All collected data are present within the core of the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Omer Ozturk, MD, Department of Gastroenterology, Hacettepe University School of Medicine, 06100 Ankara, Turkey. omr58oztrk@hotmail.com
Telephone: +90-505-9487945
Received: May 6, 2016
Peer-review started: May 8, 2016
First decision: June 20, 2016
Revised: July 11, 2016
Accepted: July 31, 2016
Article in press: August 1, 2016
Published online: November 21, 2016
Processing time: 195 Days and 18.5 Hours
Abstract
AIM

To determine the outcomes of partial splenic embolization (PSE) for massive splenomegaly due to idiopathic portal hypertension (IPH).

METHODS

In this prospective study, we evaluated the characteristics and prognosis of consecutive patients with IPH who underwent PSE for all indications at a single medical center between June 2009 and January 2015. The inclusion criteria were: presence of hypersplenism, massive splenomegaly, and resultant pancytopenia. The exclusion criteria were: presence of other diseases causing portal hypertension. During the post-PSE period, the patients were hospitalized. All patients underwent abdominal computed tomography imaging 4 wk post-PSE to determine total splenic and non-infarcted splenic volumes.

RESULTS

A total of 11 patients, with median age of 33.27 ± 4.8 years, were included in the study. Mean spleen size was 22.9 cm (21-28 cm), and severe hypersplenism was diagnosed in all patients before PSE. Post-PSE, leukocyte and platelet counts increased significantly, reaching peak levels in the second week with gradual decreases thereafter. Liver function tests did not exhibit significant changes during post-intervention follow-up. All patients developed post-embolization syndrome, and one patient experienced serious complications; all complications were successfully treated with conservative therapy and no death occurred.

CONCLUSION

Our findings showed that PSE has a lower complication rate than previously-reported surgical complication rates, which supports this intervention as a viable alternative for high-risk operable patients with severe hypersplenism.

Keywords: Partial splenic embolization; Idiopathic portal hypertension; Hypersplenism; Massive splenomegaly

Core tip: Partial splenic embolization (PSE) for hypersplenism is a novel percutaneous interventional method, has emerged as an alternative to surgery and is a viable approach in high-risk and inoperable patients with portal hypertension. The current trial, which is the largest study in the current literature, confirmed the safety and efficacy of PSE in patients with idiopathic portal hypertension (IPH) regarding complications and morbidity. PSE could be offered to patients with massive splenomegaly due to IPH, with low and manageable complication rates, as this study has confirmed.