Retrospective Comparison of Clinical Outcomes Following Splenic Vein Stenting and Splenic Arterial Embolization in Sinistral Portal Hypertension-Related Gastrointestinal Bleeding.

Abstract

BACKGROUND. Sinistral portal hypertension (SPH) is caused by an obstruction of the splenic vein and is a potential cause of upper gastrointestinal bleeding. Although splenic arterial embolization (SAE) and splenic vein stenting are accepted treatment options for SPH, their outcomes have not been compared directly. OBJECTIVE. This retrospective study compared the outcomes of splenic vein stenting and SAE for SPH-related gastrointestinal bleeding. METHODS. Data of patients with SPH treated by interventional radiology between January 1, 2013, and June 1, 2019, who had at least 6 months of clinical follow-up were retrospectively identified from the electronic database at our hospital. Patients were divided into the SAE group (SAE alone), splenic vein stenting-SAE group (SAE immediately after splenic vein stenting failure using the same procedure as the SAE group), and splenic vein stenting group (successful treatment with SVS). Patients' baseline characteristics and follow-up data were retrieved, and their clinical outcomes were compared. RESULTS. Thirty-seven patients with SPH were included. We assigned 11, 12, and 14 patients to the SAE, splenic vein stenting-SAE, and splenic vein stenting groups, respectively. Rebleeding (e.g., hematemesis, melena, or both) was significantly less common (p = .01) in the splenic vein stenting group (7.1% [1/14]) than in the SAE and splenic vein stenting-SAE groups combined (47.8% [11/23]). Splenectomy to resolve rebleeding was not significantly different (p = .63) in the splenic vein stenting group (7.1% [1/14]) compared with the SAE and splenic vein stenting-SAE groups combined (17.4% [4/23]). No interventional procedure-related deaths were observed during follow-up in any group. CONCLUSION. When feasible, splenic vein stenting is a safe and effective treatment of SPH-related gastrointestinal bleeding that appears to better prevent rebleeding than SAE. CLINICAL IMPACT. Splenic vein stenting should be recommended over SAE for the treatment of SPH-related upper gastrointestinal bleeding when possible.