Clinical Trials Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2023; 15(4): 655-663
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.655
Endoscopic ultrasound-guided intraportal injection of autologous bone marrow in patients with decompensated liver cirrhosis: A case series
Shao-Peng Zheng, Ao-Jian Deng, Jing-Jing Zhou, Ling-Zhi Yuan, Xiao Shi, Fen Wang
Shao-Peng Zheng, Ao-Jian Deng, Jing-Jing Zhou, Ling-Zhi Yuan, Xiao Shi, Fen Wang, Department of Gastroenterology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Shao-Peng Zheng, Ao-Jian Deng, Ling-Zhi Yuan, Fen Wang, Hunan Key Laboratory of Non-resolving Inflammation and Cancer, Central South University, Changsha 410000, Hunan Province, China
Author contributions: Wan F designed the research; Zheng SP, Zhou JJ, Yuan LZ, Shi X, and Wan F performed the research; Zheng SP analyzed the data; Zheng SP and Deng AJ wrote the paper.
Supported by the National Natural Science Foundation of China, No. 82270594; National Natural Science Foundation for Youths of China, No. 882002614 and No. 82103151; Hunan Provincial Natural Science Foundation of China, No. 2020JJ4853; Scientific Research Project of Hunan Provincial Health Commission, No. 202103032097; Outstanding Youth Foundation of Hunan Province, No. 2022JJ20092; Hunan Provincial Natural Science Foundation of China for Youths, No. 2021JJ40935 and No. 2020JJ5609; and Wisdom Accumulation and Talent Cultivation Project of Third Xiangya Hospital of Central South University, No. YX202103.
Institutional review board statement: This study was reviewed and approved by the institutional ethics committee of the local hospital (Approval No. 2018-S403).
Clinical trial registration statement: This study is registered at Chinese Clinical Trial Registry https://www.chictr.org.cn. The registration identification number is ChiCTR2000035269.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: The data presented in this study are available on request from the corresponding author.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fen Wang, MD, PhD, Doctor, Professor, Department of Gastroenterology, Third Xiangya Hospital of Central South University, No. 138 Tongzi Road, Changsha 410013, Hunan Province, China. wfen-judy@csu.edu.cn
Received: October 17, 2022
Peer-review started: October 17, 2022
First decision: January 3, 2023
Revised: January 31, 2023
Accepted: March 21, 2023
Article in press: March 21, 2023
Published online: April 27, 2023
Processing time: 187 Days and 19.5 Hours
Abstract
BACKGROUND

Recently, stem cell therapy has been extensively studied as a promising treatment for decompensated liver cirrhosis (DLC). Technological advances in endoscopic ultrasonography (EUS) have facilitated EUS-guided portal vein (PV) access, through which stem cells can be precisely infused.

AIM

To investigate the feasibility and safety of fresh autologous bone marrow injection into the PV under EUS guidance in patients with DLC.

METHODS

Five patients with DLC were enrolled in this study after they provided written informed consent. EUS-guided intraportal bone marrow injection with a 22G FNA needle was performed using a transgastric, transhepatic approach. Several parameters were assessed before and after the procedure for a follow-up period of 12 mo.

RESULTS

Four males and one female with a mean age of 51 years old participated in this study. All patients had hepatitis B virus-related DLC. EUS-guided intraportal bone marrow injection was performed in all patients successfully without any complications such as hemorrhage. The clinical outcomes of the patients revealed improvements in clinical symptoms, serum albumin, ascites, and Child-Pugh scores throughout the 12-mo follow-up.

CONCLUSION

The use of EUS-guided fine needle injection for intraportal delivery of bone marrow was feasible and safe and appeared effective in patients with DLC. This treatment may thus be a safe, effective, non-radioactive, and minimally invasive treatment for DLC.

Keywords: Endoscopic ultrasonography; Fine needle injection; Portal vein; Decompensated liver cirrhosis; Bone marrow

Core Tip: In this study, we showed that the use of endoscopic ultrasonography (EUS)-guided fine needle injection for intraportal delivery of stem cells was feasible and safe and appeared effective in patients with decompensated liver cirrhosis (DLC). And it is the first attempt to investigate the feasibility and safety of fresh autologous bone marrow injection into the portal vein under EUS guidance in patients with DLC.