COMPARATIVE ANALYSIS OF THE EFFICIENCY OF SPLENIC ARTERY EMBOLIZATION AND ENDOSCOPIC SCLEROTHERAPY IN SECONDARY PREVENTION OF ESOPHAGEAL VARICEAL BLEEDING
DOI:
https://doi.org/10.11603/2414-4533.2026.1.16067Keywords:
liver fibrosis, liver cirrhosis, portal hypertension, splenic artery embolization, sclerotherapy, esophageal varices, secondary prevention of bleedingAbstract
The aim of the work: to compare the clinical efficacy and impact on survival of endovascular splenic artery embolization (SAE) and endoscopic sclerotherapy (ES) in patients with liver cirrhosis.
Materials and Methods. The retrospective-prospective study included 271 patients (Group I (SAE), n=120; Group II (ES), n=151). The groups were homogeneous by age and Child-Pugh class. All patients received baseline therapy with non-selective beta-blockers. An original integral scale was used to assess the results.
Results. Splenic artery embolization provided a stable clinical result in 77.5 % of cases versus 49.7 % with sclerotherapy (p<0.001). The annual mortality rate in the SAE group was 13.3 %, while in the ES group it was 38.4 %. Kaplan – Meier cumulative survival was 0.87 versus 0.64 in favor of the endovascular method. The results of the comprehensive comparative analysis convincingly indicate that ECA should be considered a priority method for secondary prevention of bleeding compared to EC. A significant difference in the structure of clinical outcomes between the groups was found (p<0.001).
Conclusions. Splenic artery embolization is a pathogenetically grounded, highly effective, and safe method of prevention, superior to local endoscopic techniques, especially in patients with severe hepatic dysfunction.
Received: 09.01.2026 | Revised: 26.01.2026 | Accepted: 23.02.2026
References
De Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C. Baveno VII. Renewing consensus in portal hypertension. J Hepatol. 2022; 76(4):959-74. DOI: 10.1016/j.jhep.2021.12.022.
Helaly AZ, Al-Warraky MS, El-Azab GI, Kohla MA, Abdelaal EE. Portal and splanchnic hemodynamics after partial splenic embolization in cirrhotic patients with hypersplenism. APMIS. 2015; 123(12):1032-9. DOI: 10.1111/apm.12470.
Zhu K, Meng X, Qian J, Huang M, Li Z, Guan S, et al. Partial splenic embolization for hypersplenism in cirrhosis: a long-term outcome in 62 patients. Dig Liver Dis. 2009; 41(6):411-6. DOI: 10.1016/j.dld.2008.10.005.
Yoshida H, Mamada Y, Taniai N, Tajiri T. Partial splenic embolization. Hepatol Res. 2008; 38(3):225-33. DOI: 10.1111/j.1872-034X.2007.00302.x.
Kozlov S, Fomin P, Nikishin A, Sidorenko V. Modified SAE technique provides a long last sustained hemodynamic response on splenic artery blood velocity in patients with cirrhosis and clinically significant portal hypertension. J Hepatol. 2019; 70(1):e625. DOI: 10.1016/S0618-8278(19)31235-5.
Kozlov SM. Sposib analizu viddalenykh rezulʹtativ renthenendovaskulyarnoyi korektsiyi portalʹnoyi hipertenziyi [Method for analyzing remote results of X-ray endovascular correction of portal hypertension]. Patent Ukrayiny na korysnu modelʹ № 78 639 – Patent of Ukraine for utility model No. 78 639. 2013; 25. Ukrainian.
Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013; 48(3):452-8. DOI: 10.1038/bmt.2012.244.
Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med. 2010; 362(9):823-32. DOI: 10.1056/NEJMra0901512.
D'Amico G, De Franchis R; Cooperative Study Group. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology. 2003; 38(3):599-612. DOI: 10.1053/jhep.2003.50385.
Sun X, Zhang A, Zhou T, Wang M, Chen Y, Zhou T, et al. Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial. Hepatol Int. 2021; 15(3):741-52. DOI: 10.1007/s12072-021-10155-0.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 С. М. КОЗЛОВ, О. Б. БІЛЯКОВ-БЄЛЬСЬКИЙ
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
