- Comparative analysis of secondary prophylaxis strategies for esophageal variceal bleeding in clinically manifest portal hypertension: a 12-year single-center study
Comparative analysis of secondary prophylaxis strategies for esophageal variceal bleeding in clinically manifest portal hypertension: a 12-year single-center study
Paediatric Surgery (Ukraine). 2025. 4(89): 32-40. doi: 10.15574/PS.2025.4(89).3240
Kozlov S. M.1, Kosei N. V.2, Leshchynska N. O.3, Yakovenko N. O.3, Nazarov Ya. S.4, Kozlov O. S.3
1Bohomolets National Medical University, Kyiv, Ukraine
2Center of Innovative Medical Technologies of the NAS of Ukraine, Kyiv
3Shupyk National University of Healthcare of Ukraine, Kyiv
4Kyiv Municipal Clinical Hospital No. 12, Ukraine
For citation: Kozlov SM, Kosei NV, Leshchynska NO, Yakovenko NO, Nazarov YaS, Kozlov OS. (2025). Comparative analysis of secondary prophylaxis strategies for esophageal variceal bleeding in clinically manifest portal hypertension: a 12-year single-center study. Paediatric Surgery (Ukraine). 4(89): 32-40. doi: 10.15574/PS.2025.4(89).3240.
Article received: Sep 13, 2025. Accepted for publication: Dec 12, 2025.
Recurrent variceal bleeding remains a leading cause of mortality in patients with portal hypertension (PH). Standard secondary prophylaxis strategies (SP), including non-selective β-blockers (NSBB) and endoscopic injection sclerotherapy (EIS), demonstrate suboptimal anti-recurrence efficacy.
Aim – to determine the optimal SP method for esophageal variceal bleeding (EVB) by comparing long-term outcomes of partial splenic artery embolization (PSE) versus NSBB and EIS-based strategies.
Materials and methods. This prospective and retrospective study included 514 patients who survived at least one EVB episode. SP efficacy was analyzed in three groups: NSBB monotherapy (n=243), EIS+NSBB (n=151), and PSE+NSBB (n=120). The efficacy evaluation criteria were survival and EVB recurrence rates within 12 months.
Results. During the 12-month follow-up, survival was significantly higher in the PSE group (0.87) than in the NSBB (0.73) and EIS (0.64) groups (p < 0.001), respectively. Recurrence-free status at one year was achieved in 56.2% of PSE patients, versus 35.0% in EIS and 24.3% in NSBB. All-cause mortality was lowest after PSE (13.3%) and highest in the EIS group (37.1%).
Conclusions. PSE provides significantly higher SP efficacy compared to standard strategies, offering an effective minimally invasive treatment for high-risk patients with clinically significant PH.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study approved by the Local Ethics Committee. Informed consent was obtained from all patients. The authors declare no conflict of interest.
Keywords: portal hypertension, esophageal varices, variceal bleeding, secondary prophylaxis, partial splenic artery embolization, endoscopic injection sclerotherapy.
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