The risk of developing splanchnic vein thrombosis in acute pancreatitis increases 3 days after symptom onset: A systematic review and meta-analysis

Ruben Zsolt Borbély; Eszter Ágnes Szalai; Bryan Mangalath Philip; Dalma Dobszai; Brigitta Teutsch; Ádám Zolcsák; Dániel Sándor Veres; Bálint Erőss; Bálint Gellért; Péter Jenő Hegyi; Péter Hegyi; Nándor Faluhelyi

doi:10.1002/ueg2.12550

The risk of developing splanchnic vein thrombosis in acute pancreatitis increases 3 days after symptom onset: A systematic review and meta-analysis

United European Gastroenterol J. 2024 Feb 24. doi: 10.1002/ueg2.12550. Online ahead of print.

Authors

Ruben Zsolt Borbély^{1

2}, Eszter Ágnes Szalai^{1

3}, Bryan Mangalath Philip¹, Dalma Dobszai⁴, Brigitta Teutsch^{1

4}, Ádám Zolcsák^{1

5}, Dániel Sándor Veres^{1

5}, Bálint Erőss^{1

4

6}, Bálint Gellért^{1

7}, Péter Jenő Hegyi^{1

6}, Péter Hegyi^{1

4

6

8}, Nándor Faluhelyi^{1

9}

Affiliations

¹ Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
² Department of Medical Imaging, Bajcsy-Zsilinszky Hospital and Clinic, Budapest, Hungary.
³ Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary.
⁴ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
⁵ Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.
⁶ Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary.
⁷ Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary.
⁸ Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation, University of Szeged, Szeged, Hungary.
⁹ Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary.

PMID: 38400822
DOI: 10.1002/ueg2.12550

Abstract

Background: Splanchnic vein thrombosis is a complication of acute pancreatitis (AP) and is likely often underdiagnosed.

Objectives: We aimed to understand the time course and risk factors of splanchnic vein thrombosis in the early phase of AP.

Methods: A systematic search was conducted using the PRISMA guidelines (PROSPERO registration CRD42022367578). Inclusion criteria were appropriate imaging techniques in adult AP patients, studies that reported splanchnic vein thrombosis data from the early phase, and reliable information on the timing of imaging in relation to the onset of pancreatitis symptoms or hospital admission. The proportion of patients with thrombosis with 95% confidence intervals (CI) was calculated using random-effects meta-analyses, and multiple subgroup analyses were performed.

Results: Data from 1951 patients from 14 studies were analyzed. The proportion of patients with splanchnic vein thrombosis within 12 days after symptom onset was 0.13 (CI 0.07-0.23). The occurrence was lowest at 0.06 (CI 0.03-0.1) between 0 and 3 days after symptom onset, and increased fourfold to 0.23 (CI 0.16-0.31) between 3 and 11 days. On hospital admission, the proportion of patients affected was 0.12 (CI 0.02-0.49); it was 0.17 (CI 0.03-0.58) 1-5 days after admission. The prevalence in mild, moderate, and severe AP was 0.15 (CI 0.05-0.36), 0.26 (CI 0.15-0.43), and 0.27 (CI 0.17-0.4), respectively. Alcoholic etiology (0.31, CI 0.13-0.58) and pancreatic necrosis (0.55, CI 0.29-0.78, necrosis above 30%) correlated with increased SVT prevalence.

Conclusion: The risk of developing splanchnic vein thrombosis is significant in the early stages of AP and may affect up to a quarter of patients. Alcoholic etiology, pancreatic necrosis, and severity may increase the prevalence of splanchnic vein thrombosis.

Keywords: portal vein thrombosis; portosplenomesenteric venous thrombosis; splenic vein thrombosis; superior mesenteric vein thrombosis.

Abstract

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