High-intensity focused ultrasound safe, effective for cirrhotic secondary hypersplenism
08 Dec 2022
High-intensity focused ultrasound (HIFU) appears to be a safe, effective, and minimally invasive treatment option for patients with cirrhotic secondary hypersplenism, a recent study has found.
From October 2019 to May 2021, the present case series enrolled 11 patients who had cirrhotic secondary hypersplenism. Eight (72.7 percent) participants had Child-Pugh A disease, while the remaining three were classified as Child-Pugh B. Five patients also had gallstones, two of whom had multiple small stones.
HIFU was successful in all 11 patients, with a mean ablated volume of 577.21 cm3. This represented a 35-percent to 61-percent ablated volume to spleen volume ratio. Before the procedure, the mean spleen volume was 1,297.80 cm3.
Three main complications occurred after HIFU. The first was skin lesions, with seven patients (63.6 percent) showing subcutaneous ecchymosis of the waist. The second main complication was ablated area pain, with three patients (27.3 percent) complaining of mild pain in the upper left abdomen. The final complication was choledocholithiasis.
Of note, two patients who had chronic cholecystitis with multiple small gallstones reported severe abdominal pain, jaundice, and fever on the third and eighth day after HIFU. Magnetic resonance imaging revealed several small stones in the common bile duct.
“This series suggested that HIFU is an effective and safe treatment for cirrhotic secondary hypersplenism in patients classified as Child-Pugh A or B. However, multiple small gallstones could be a relative contraindication for it,” the researchers said.
“A large-sample multicenter clinical trial with a long-term follow-up is required to illustrate the proper indications, contraindications, ablation volume as well as the most appropriate ablation area for HIFU in the treatment of secondary hypersplenism,” they added.