Copyright © ESPGHAN and NASPGHAN. All rights reserved. Partial Splenic Embolization Is a Safe and Effective Alternative in the Management of Portal Hypertension in Children  Jennifer Vittorio, y Katherine Orellana,  Mercedes Martinez, z Nadia Ovchinsky, § Peter Schlossberg, jj Adam Griesemer, and  Steven Lobritto ABSTRACT Objective: There are multiple approaches to manage the clinical complications of portal hypertension (PHTN) to treat/prevent spontaneous hemorrhage by mitigating thrombocytopenia. No single approach is ideal for all patients given the heterogeneity of this population. Our goal was to determine whether partial splenic embolization (PSE) was safe and effective in the pediatric population. Methods: This is a retrospective review of our single-center experience for all patients ages 0 to 21 who underwent PSE between January 2010 and August 2017. The embolized splenic volume targeted was 60% to 70%. Results: Twenty-six patients underwent PSE due to thrombocytopenia and/or recurrent variceal bleeding. Patients ranged in age from 18 months to 20 years (mean 13.1 years). The median platelet count before PSE was 53.0 (10 9 /L). The platelet count improved after PSE with values >100,000 in 21 patients (80.8%). Children with prior esophageal varices showed improvement after PSE with only 9 (34.6%) requiring further endoscopic therapy. After PSE, patients developed transient abdominal pain, distention, fever, and perisplenic fluid collections. Serious complications such as splenic abscess, splenic rupture, bleeding, pancreatic infarction, opportunistic infection, or death were not observed. One patient experienced thrombotic complications after PSE and was later diagnosed with myelodysplastic syndrome. Conclusions: PSE is a safe and effective alternative in the management of pediatric PHTN in select populations. PSE may be a favorable alternative to splenectomy and portal systemic shunting because it preserves functional spleen mass and avoids postprocedure accelerated liver disease or encephalopathy. Key Words: gastroesophageal varices, pediatrics, splenomegaly, thrombocytopenia (JPGN 2019;68: 793–798) What Is Known  There are multiple approaches to manage the clinical complications of portal hypertension to treat/prevent variceal bleeding and spontaneous hemorrhage by mitigating thrombocytopenia.  No single approach is ideal for all patients given the heterogeneity of this population. What Is New  Partial splenic embolization is a safe, effective, semi- invasive alternative to splenectomy in patients with portal hypertension in select situations.  Partial splenic embolization can be successfully performed in pre-and post-liver transplant patients, and select cirrhotic and noncirrhotic pediatric patients.  Partial splenic embolization may be a favorable alter- native to splenectomy and portal systemic shunting because it preserves functional spleen mass and avoids postprocedure accelerated liver disease or encephalopathy. P ortal hypertension (PHTN) may stem from a wide variety of conditions. It frequently presents with splenomegaly result- ing in leukopenia, thrombocytopenia, and the formation of collateral circulation including esophageal varices. PHTN devel- ops when there is resistance to portal blood flow and is aggra- vated by increased portal collateral inflow. Resistance occurs at different levels including prehepatic (ie, portal vein thrombosis), intrahepatic (eg, cirrhosis), or posthepatic (eg, Budd-Chiari syndrome). The combination of thrombocytopenia and signifi- cant esophageal varices predisposes to potential life-threatening hemorrhage (1,2). Traditionally, complications of PHTN have been managed with serial endoscopic variceal ligation (EVL) or invasive open surgical procedures including splenectomy, portosystemic shunt- ing or orthotopic liver transplantation (OLT) (3,4). EVL directly treats varices, but does not address the underlying etiology of PHTN and often requires repeated procedures with recurrent anesthesia exposure. Portosystemic shunting reduces the risk of hemorrhage by decreasing portal pressure. Surgical intervention, however, may exacerbate underlying liver disease resulting in Received March 29, 2018; accepted February 13, 2019. From the  Department of Pediatrics, Columbia University Medical Center, New York, NY, the y Department of Pediatrics, Valley Health System, Ridgewood, NJ, the z Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, the § Department of Radiology, Columbia University Medical Center, and the jj Department of Surgery, Columbia University Medical Center, New York, NY. Address correspondence and reprint requests to Jennifer Vittorio, MD, Columbia University College of Physicians and Surgeons, Center for Liver Disease and Transplantation, NewYork-Presbyterian Morgan Stanley Children’s Hospital, 622 West 168th St, PH 17, New York, NY 10032-3784 (e-mail: jmv2152@cumc.columbia.edu). Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jpgn.org). This research was supported by the Department of Surgery, Center for Liver Disease and Transplantation at Columbia University Medical Center. The authors report no conflicts of interest. Copyright # 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition DOI: 10.1097/MPG.0000000000002332 ORIGINAL ARTICLE:HEPATOLOGY JPGN  Volume 68, Number 6, June 2019 793