Introduction
Splanchnic vein thrombosis (SVT) is a local complication of acute pancreatitis (AP) that may lead to subsequent complications such as portal hypertension, gastrointestinal bleeding, and mesenteric ischemia.1,2 Despite its clinical significance, there is limited data in the literature concerning the temporal development and associated risk factors of SVT.
Aims & Methods
Our aim was to understand the time course and risk factors of SVT in the early phase of AP. To identify relevant studies we conducted a systematic search across four major medical databases (Embase, MEDLINE via PubMed, Scopus, and Cochrane Central Register of Controlled Trials) on 27th of October 2022. We included studies that employed appropriate imaging techniques in adult patients with AP, reported SVT data from the early phase of AP, and provided reliable information about the timing of imaging relative to AP symptom onset or hospital admission. We excluded studies that reported data on patients with a recent history of malignant disease or recent surgical procedures. We calculated the proportion of patients affected by SVT with 95% confidence intervals (CI). We conducted subgroup analyses based on diagnostic timing and disease characteristics. To assess the risk of bias we used the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies and the GRADEpro tool to determine the level of evidence. The protocol for this method was registered prospectively in the PROSPERO database, with registration number CRD42022367578.
Results
Data from 14 eligible studies and 1,951 patients was pooled; the proportion of patients with SVT in the early phase of AP (within 11 days after symptom onset or 5 days after hospital admission) was 0.13 (CI 0.07-0.23). The occurrence was lowest 0-3 days after symptom onset at 0.06 (CI 0.03-0.1), it increased to 0.23 (CI 0.16-0.31) between 3-11 days. Disease factors influencing SVT occurrence were severity (mild: 0.14 (CI 0.04-0.39), moderate: 0.23 (CI 0.09-0.47), severe: 0.31 (CI 0.15-0.54), p=0.21), etiology (alcoholic 0.31 (CI 0.13-0.58), biliary 0.12 (CI 0.04-0.3), p=0.03), and pancreatic necrosis (absent 0.10 (CI 0.04-0.25), under 30% 0.25 (CI 0.1-0.5), over 30% 0.55 (CI 0.29-0.78), p= 0.01).
Conclusion
One in eight patients develops SVT in the early phase of AP. Alcoholic etiology and pancreatic necrosis increase the risk of SVT. In addition, this risk seems to increase with the duration of AP; therefore, looking for and diagnosing SVT with imaging is important in the management of AP.
References
1. Nawacki L, Matykiewicz J, Stochmal E, Gluszek S. Splanchnic Vein Thrombosis in Acute Pancreatitis and Its Consequences. Clin Appl Thromb Hemost. 2021;27.
2. Valeriani E, Riva N, Di Nisio M, Ageno W. Splanchnic Vein Thrombosis: Current Perspectives. Vascular Health and Risk Management. 2019;15.
