Role of partial splenic embolization combined with endoscopic therapies in cirrhotic patients with hypersplenism having variceal bleed: An observational study.

This is an observational study. The study will be carried out at the Surgery Department of JIPMER after obtaining Institute’s Ethical committee approval. All patients will be informed about the study and written informed consent will be taken before participation. The patients qualifying the inclusion and exclusion criteria for this study will be recruited for the study. Liver cirrhosis will be diagnosed by an ultrasound evaluation. Baseline blood investigations including haemoglobin, total leukocyte count, platelet count, renal and liver functions will be done. After stabilizing the hemodynamics, the patients will undergo endoscopic examination and endoscopic treatment in the department of Surgery, JIPMER.EVL will be carried out for oesophageal varices at 1 cm above the Z-line in a spirally ascending fashion. After the initial session, EVL will be performed at regular intervals of about 2 weeks till eradication of varices. Eradication of the varices will be defined as no visible varices in endoscopy or the presence of only fibrosed varices not requiring ligation. Partial Splenic Embolization will be performed 1 week after the endoscopic treatment in patients with hypersplenism and thrombocytopenia. These patients will undergo contrast enhanced computed tomography (CECT) scanning to observe the basal status of the spleen. Splenic arteriography will be performed on a digital subtraction angiography (DSA) system via the femoral artery access. Progressive embolization of splenic artery will be performed as the standard of care by repeated injections of a gelatin sponge under the DSA control until a 60–80% reduction in the splenic blood flow is achieved. Broad-spectrum antibiotic prophylaxis will be administered in the peri-intervention period. A post-interventional enhanced CT scan will be  performed to confirm the embolization area 2–3 weeks after the PSE. Patients without hypersplenism (group 2) will undergo endoscopic management alone. A standard dose of NSBB (propranolol) will be given to all patients if there were no contraindications. The primary endpoint of the study will be variceal rebleeding and the secondary endpoints will be severe variceal recurrence and mortality during the 3 month follow-up. In the follow up period blood investigations including haemoglobin, total leukocyte count, platelet count, renal and liver functions will be will be