1
|
Liu M, Wei N, Song Y. Splenectomy versus non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis. Therap Adv Gastroenterol 2024; 17:17562848241234501. [PMID: 38450104 PMCID: PMC10916482 DOI: 10.1177/17562848241234501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Objectives Left-sided portal hypertension (LSPH) leads to life-threatening gastrointestinal (GI) bleeding. There are no recommendations or consensus about the management of GI bleeding caused by LSPH. This systematic review and meta-analysis were conducted to evaluate the incidence of GI bleeding and the mortality of patients with LSPH receiving different therapeutic strategies. Design A systematic review and meta-analysis were performed to determine the efficacy of different therapeutic strategies for GI bleeding caused by LSPH. Data sources and methods All relevant studies were searched from PubMed, Embase, Web of Science, Cochrane Library, Scopus, ScienceDirect, MEDLINE, Google Scholar, CNKI, and Wanfang Data without language restriction through 15 November 2023. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated through RevMan5.3 software. (The Cochrane Collaboration, Copenhagen, Denmark). Results Seventeen retrospective studies and one prospective study involving 624 patients were included. This systematic review and meta-analysis found that: (1) splenectomy was more effective than non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding caused by LSPH (OR: 0.12; 95% CI: 0.06-0.27); (2) splenectomy was superior to partial splenic artery embolism (PSAE) (OR: 0.06; 95% CI: 0.01-0.62) or endoscopic interventions (OR: 0.04; 95% CI: 0.01-0.19) in the prevention of GI bleeding, respectively; (3) no significant difference in the mortality was observed between splenectomy and non-splenectomy therapeutic strategies (OR: 0.46; 95% CI: 0.20-1.08); and (4) patients receiving preoperative PSAE followed by splenectomy had less intraoperative bleeding and shorter operative time than those receiving splenectomy. Conclusion This meta-analysis demonstrated that splenectomy is superior to non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding from LSPH, which revealed that splenectomy should be recommended in the management of these patients. Trial registration This study has been registered on the PROSPERO database with the registration number CRD42023483764.
Collapse
Affiliation(s)
- Minghui Liu
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ning Wei
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuhu Song
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| |
Collapse
|
2
|
Li X, Li W, Wu Y, Liu Y. Varicose vein embolization and portal vein stenting in a patient with sinistral portal hypertension-induced gastrointestinal hemorrhage: a case report. Ann Med Surg (Lond) 2024; 86:485-488. [PMID: 38222742 PMCID: PMC10783337 DOI: 10.1097/ms9.0000000000001460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/20/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction and importance Massive gastrointestinal hemorrhage is a severe hemorrhage that occurs in the gastrointestinal tract and is a life-threatening condition. Sinistral portal hypertension is a common etiology for massive gastrointestinal hemorrhage, whose occurrence might be derived from pathological changes induced by obstruction and/or increased blood flow to the portal vein system. However, there is a rare study reporting pancreatic disease-induced sinistral portal hypertension. Case presentation An 80-year-old female pancreatic cancer patient was admitted to our hospital on 22 January 2022 due to a massive gastrointestinal hemorrhage with shock after receiving radio-chemotherapy. Abdominal enhanced computerized tomography showed that the patient presented with pancreatic cancer-causing sinistral portal hypertension with massive collateral circulation, intrahepatic bile duct dilation, and the formation of massive ascites. Subsequent portography interventional procedure revealed the esophageal and gastric varix. Then, the varicose vein was embolized, and the stent was implanted at the lumen of the superior mesenteric vein accessing the portal vein. The patient recovered from pancreatic cancer-causing sinistral portal hypertension, and a normal direction of blood flow was observed in the superior mesenteric vein with a decreasing amount of ascites. In addition, a transfusion was also carried out, and the massive gastrointestinal hemorrhage was alleviated. Clinical discussion and conclusion This study emphasizes the successful treatment of massive gastrointestinal hemorrhage induced by pancreatic cancer-causing sinistral portal hypertension by varicose vein embolization and portal vein stenting, which could be considered an alternative opinion for these patients.
Collapse
Affiliation(s)
| | | | | | - Yuan Liu
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| |
Collapse
|
3
|
Povzun SA. [Varicose veins of the esophagus as a manifestation of left-sided portal hypertension]. Arkh Patol 2023; 85:45-47. [PMID: 37814849 DOI: 10.17116/patol20238505145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
An autopsy of pancreatic cancer in a woman who died from acute posthemorrhagic anemia due to repeated bleeding from esophageal varices is presented. The mechanism of development of esophageal varices associated with the so-called left-sided portal hypertension, caused by compression of the splenic vein by the tumor and the opening of porto-caval anastomoses, is considered. A brief review discusses other possible causes of left-sided portal hypertension syndrome and its consequences.
Collapse
Affiliation(s)
- S A Povzun
- I.I. Dzanelidze Saint-Petersburg Scientific Research Institute of Emergency Aid, St. Petersburg, Russia
| |
Collapse
|
4
|
Wang YL, Zhang HW, Lin F. Computed tomography combined with gastroscopy for assessment of pancreatic segmental portal hypertension. World J Clin Cases 2022; 10:8568-8577. [PMID: 36157801 PMCID: PMC9453378 DOI: 10.12998/wjcc.v10.i24.8568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/13/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pancreatic segmental portal hypertension (PSPH) is the only type of portal hypertension that can be completely cured. However, it can easily cause varicose veins in the esophagus and stomach and hemorrhage in the digestive tract.
AIM To explore the application of computed tomography (CT) to examine the characteristics of PSPH and assess the risk level.
METHODS This was a retrospective analysis of CT images of 22 patients diagnosed with PSPH at our center. Spearman correlation analysis was performed using the range of esophageal and gastric varices (measured by the vertical gastric wall), the ratio of the width of the splenic portal vein to that of the compression site (S/C ratio), the degree of splenomegaly, and the stage determined by gastroscopy. This study examined whether patients experienced gastrointestinal bleeding within 2 wk and combined CT and gastroscopy to explore the connection between bleeding and CT findings.
RESULTS The range of esophageal and gastric varices showed the best correlation in the diagnosis of PSPH (P < 0.001), and the S/C ratio (P = 0.007) was correlated with the degree of splenomegaly (P = 0.021) and PSPH (P < 0.05). This study revealed that male patients were more likely than females to progress to grade 2 or grade 3 as determined by gastroscopy. CT demonstrated excellent performance, with an area under the curve of 0.879.
CONCLUSION CT can be used to effectively analyze the imaging signs of PSPH, and CT combined with gastroscopy can effectively predict the risk level of gastrointestinal bleeding.
Collapse
Affiliation(s)
- Yu-Li Wang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
| | - Han-Wen Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
| |
Collapse
|
5
|
Yu C, Ding L, Jiang M, Liao Q, Huang X, Lei Y, Ke H, Xiong H, He W, Xia L, Zeng X, Lu N, Zhu Y. Dynamic Changes and Nomogram Prediction for Sinistral Portal Hypertension in Moderate and Severe Acute Pancreatitis. Front Med (Lausanne) 2022; 9:875263. [PMID: 35721067 PMCID: PMC9198833 DOI: 10.3389/fmed.2022.875263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate the dynamic changes in gastric varices in patients with acute pancreatitis (AP) and to develop a novel nomogram for the early prediction of sinistral portal hypertension (SPH). Methods This was a retrospective, case-control study with an analysis of the quantitative, dynamic computed tomography imaging results of SPH in patients with moderate and severe AP with a long-term follow-up. Multivariate logistic regression analysis and nomogram were employed. Results The SPH group (n = 94) and non-SPH group (n = 94) were matched. The dynamic changes showed an increasing trend in the diameter of gastric fundus, short gastric, gastric coronary, and gastroepiploic veins, which did not recover during the one-year follow-up. Multivariate analysis showed that male (adjusted odds ratio (adjOR), 8.71; 95% confidence interval (CI), 2.86–26.53; P < 0.001), body mass index ≥27.5 kg/m2 (adjOR, 5.49; 95% CI, 1.85–16.29; P = 0.002), prothrombin time ≥12.6 s (adjOR, 2.82; 95% CI, 1.11–7.17; P = 0.03), and the patency of splenic vein [stenosis (adjOR, 8.48; 95% CI, 2.13–33.71; P = 0.002), and occlusion (adjOR, 34.57; 95% CI, 10.87–110.00; P < 0.001)] were independently associated with the development of SPH. The nomogram incorporating these factors demonstrated good discrimination, calibration and clinical utility. The area under the curve was as high as 0.92 (95% CI, 0.87–0.95). Conclusion The dynamic changes in varices in SPH are long-term and slowly progressing. Males and obese patients with abnormal splenic veins and coagulopathies are at high risk for developing SPH. A simple nomogram tool helps in the early, accurate prediction of SPH.
Collapse
Affiliation(s)
- Chen Yu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Ling Ding
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meilan Jiang
- Gaoxin Hospital of the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qian Liao
- Jiangxi Province Medical Imaging Research Institute, Nanchang, China.,Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xin Huang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yupeng Lei
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huajing Ke
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huifang Xiong
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenhua He
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liang Xia
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xianjun Zeng
- Jiangxi Province Medical Imaging Research Institute, Nanchang, China.,Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Nonghua Lu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
6
|
Nagarajan K, Sunilkumar D, Ramakrishnaiah VPN, Amuthabarathi M. Left Gastric Pseudoaneurysm in a Case of Chronic Pancreatitis: A Case Report With Review of Literature. Vasc Endovascular Surg 2020; 55:73-76. [PMID: 32869730 DOI: 10.1177/1538574420954309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Visceral artery pseudoaneurysms are common complications of pancreatitis that carry a high mortality rate. Early detection and treatment of the pseudoaneurysms should be done as they carry high mortality following rupture. The splenic artery is the commonest artery involved followed by gastroduodenal and pancreaticoduodenal arteries. Gastric artery pseudoaneurysms are less common with less than 50 cases reported in the literature till now. We describe a case of gastric artery pseudoaneurysm secondary to chronic pancreatitis in a patient who presented with intermittent GI bleeding and also describe the role of endovascular management in the treatment of the same.
Collapse
Affiliation(s)
- Krishnan Nagarajan
- Department of Radio-Diagnosis, 29988Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Devaraj Sunilkumar
- Department of Radio-Diagnosis, 29988Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | | | - Mohan Amuthabarathi
- Department of Radio-Diagnosis, 29988Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| |
Collapse
|
7
|
Petrucciani N, Debs T, Rosso E, Addeo P, Antolino L, Magistri P, Gugenheim J, Ben Amor I, Aurello P, D'Angelo F, Nigri G, Di Benedetto F, Iannelli A, Ramacciato G. Left-sided portal hypertension after pancreatoduodenectomy with resection of the portal/superior mesenteric vein confluence. Results of a systematic review. Surgery 2020; 168:434-439. [PMID: 32600882 DOI: 10.1016/j.surg.2020.04.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/08/2020] [Accepted: 04/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatoduodenectomy with synchronous resection of the portal vein/superior mesenteric vein confluence may result in the development of left-sided portal hypertension. Left-sided portal hypertension presents with splenomegaly and varices and may cause severe gastrointestinal bleeding. The aim of the study is to review the incidence, treatment, and preventive strategies of left-sided portal hypertension. METHODS A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to identify all studies published up to September 30, 2019 reporting data on patients with left-sided portal hypertension after pancreatoduodenectomy with venous resection. RESULTS Eight articles including 829 patients were retrieved. Left-sided portal hypertension occurred in 7.7% of patients who had splenic vein preservation and 29.4% of those having splenic vein ligation. Fourteen cases of gastrointestinal bleeding owing to left-sided portal hypertension were reported at a mean interval of 28 months from pancreatoduodenectomy. Related mortality at 1 month was 7.1%. Treatment of left-sided portal hypertension consisted of splenectomy in 3 cases (21%) and colectomy in 1 (7%) case, whereas radiologic, endoscopic procedures or conservative treatments were effective in the other cases (71%). CONCLUSION Left-sided portal hypertension represents a potentially severe complication of pancreatoduodenectomy with venous resection occurring at greater incidence when the splenic vein is ligated and not reimplanted. Left-sided portal hypertension-related gastrointestinal bleeding although rare can be managed depending on the situation by endoscopic, radiologic procedures or operative intervention with low related mortality.
Collapse
Affiliation(s)
- Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy.
| | - Tarek Debs
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France
| | - Edoardo Rosso
- Départment de Chirurgie Générale, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - Laura Antolino
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Italy
| | - Jean Gugenheim
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France
| | - Imed Ben Amor
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France
| | - Paolo Aurello
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Francesco D'Angelo
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Italy
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France; INSERM U1065, Mediterranean Center for Molecular Medicine, Team 8 Hepatic Complications of Obesity, Nice, France
| | - Giovanni Ramacciato
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| |
Collapse
|