- Treatment outcomes and prevention of variceal bleeding in the esophagus and stomach in patients treated for chronic hepatitis C
Treatment outcomes and prevention of variceal bleeding in the esophagus and stomach in patients treated for chronic hepatitis C
Paediatric Surgery (Ukraine). 2025. 1(86): 45-52. doi: 10.15574/PS.2025.1(86).4552
Kozlov S. M.1, Ivanchov P. V.1, Lyashok O. V.3, Altman I. V.2, Lissov O. I.1, Nikishyn O. L.2, Yakovenko N. O.1, Kozlov O. S.1
1Bogomolets National Medical University, Kyiv, Ukraine
2SI "Scientific and Practical Center of Endovascular Neurosurgery", Kyiv, Ukraine
3SI “L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the NAMS of Ukraine”, Kyiv, Ukraine
For citation: Kozlov SM, Ivanchov PV, Lyashok OV, Altman IV, Lissov OI, Nikishyn OL et al. (2025). Treatment outcomes and prevention of variceal bleeding in the esophagus and stomach in patients treated for chronic hepatitis C. Paediatric Surgery (Ukraine). 1(86): 45-52. doi: 10.15574/PS.2025.1(86).4552.
Article received: Nov 29, 2024. Accepted for publication: Mar 18, 2025.
In patients with chronic hepatitis C (CHC) who have achieved a sustained virological response (SVR), the risk of developing clinically significant portal hypertension (CSPH) persists. It may be complicated by variceal bleeding (VB) from the gastroesophageal varices, which is associated with high mortality. The development of effective secondary prevention strategies is a relevant scientific challenge with significant practical and social value.
Aim – to evaluate the safety and effectiveness of endovascular splenic artery embolization (SAE) as a method of secondary prophylaxis in patients with CSPH after CHC treatment.
Materials and methods. The study involved 34 patients with ≥1 episode of esophageal VB who underwent SAE. We assessed safety and efficacy (based on bleeding recurrence), as well as hematological, biochemical, and ultrasonographic parameters before SAE and at a 12-month follow-up. Liver function was evaluated using Child-Pugh and MELD scores. All patients received standard-dose nonselective beta-blockers (NSBBs) and ursodeoxycholic acid.
Results. No deaths occurred within 12 months post-SAE. The recurrence rate decreased tenfold (from 2.71 to 0.26 episodes per patient). Spleen volume decreased from 811 cm³ to 479 cm³; platelet count increased (from 78.5 to 143)×10³/µL; hemoglobin and thrombocrit levels also improved. Child-Pugh and MELD scores showed positive dynamics.
Conclusions. In patients successfully treated for CHC, the risk of progression of portal hypertension and the occurrence of life-threatening complications in the form of VB is not eliminated. SAE is a safe and effective method for secondary prevention of VB in patients with CHC who have achieved SVR.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. Informed consent was obtained from patients.
The authors declare no conflict of interest.
Keywords: chronic hepatitis C, endovascular splenic artery embolization, secondary prophylaxis, variceal bleeding, esophagus, portal hypertension, splenomegaly, thrombocytopenia.
REFERENCES
1. De Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C et al. (2022, Apr). Baveno VII – Renewing consensus in portal hypertension. J Hepatol. 76(4): 959-974. Epub 2021 Dec 30. doi: 10.1016/j.jhep.2021.12.022. Erratum in: J Hepatol. 2022 Jul; 77(1): 271. https://doi.org/10.1016/j.jhep.2022.03.024; PMid:35431106
2. Fleckenstein FN, Luedemann WM, Kücükkaya A, Auer TA, Plewe J, Hamm B et al. (2022, Mar 10). Günther RW, Fehrenbach U, Gebauer B, Wieners G. Splenic artery steal syndrome in patients with orthotopic liver transplant: Where to embolize the splenic artery? PLoS One. 17(3): e0263832. https://doi.org/10.1371/journal.pone.0263832 ;PMid:35271572 PMCid:PMC8912229
3. Funes FR, da Silva RCMA, Arroyo Jr PC, Duca WJ, da Silva AAM, da Silva RF. Mortality and complications in patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) – 12 years experience. Arq. Gastroenterol. 49(2). https://doi.org/10.1590/S0004-28032012000200009; PMid:22767002
4. Ghany MG, Morgan TR; AASLD-IDSA Hepatitis C Guidance Panel. (2020, Feb). Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases-Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Hepatology. 71(2): 686-721. https://doi.org/10.1002/hep.31060; PMid:31816111 PMCid:PMC9710295
5. Kanda Y. (2013). Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 48: 452-458. https://doi.org/10.1038/bmt.2012.244; PMid:23208313 PMCid:PMC3590441
6. Kozlov S. (2024). Clinical Implementation of SAE in Patients with Portal Hypertension. Wiad Lek. 77(5): 108-114. https://doi.org/10.36740/WLek202405108; PMid:39008579
7. Reiberger T, Hofer BS. (2023). The Baveno VII concept of cirrhosis recompensation. Digestive and Liver Disease. 55(4): 431-441. https://doi.org/10.1016/j.dld.2022.12.014; PMid:36646527
8. Van der Meer AJ, Feld JJ, Hofer H, Almasio PL, Calvaruso V, Fernández-Rodríguez CM et al. (2017, Mar). Risk of cirrhosis-related complications in patients with advanced fibrosis following hepatitis C virus eradication. J Hepatol. 66(3): 485-493. Epub 2016 Oct 22. https://doi.org/10.1016/j.jhep.2016.10.017; PMid:27780714