Treatment outcomes and prevention of variceal bleeding in the esophagus and stomach in patients treated for chronic hepatitis C

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.