Natural history of pancreatitis-induced splenic vein thrombosis

A systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding

James R. Butler, George J. Eckert, Nicholas Zyromski, Michael J. Leonardi, Keith D. Lillemoe, Thomas Howard

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background: Pancreatitis-induced splenic vein thrombosis (PISVT) is an acquired anatomic abnormality that impacts decision making in pancreatic surgery. Despite this influence, its incidence and the rate of associated gastrointestinal (GI) bleeding are imprecisely known. Methods: The MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials and Cochrane Database of Systematic Reviews databases were searched from their inception to June 2010 for abstracts documenting PISVT in acute (AP) or chronic pancreatitis (CP). Two reviewers independently graded abstracts for inclusion in this review. Heterogeneity in combining data was assumed prior to pooling. Random-effects meta-analyses were performed to estimate percentages and 95% confidence intervals. Results: After review of 241 abstracts, 47 studies and 52 case reports were graded as relevant. These represent a cohort of 805 patients with PISVT reported in the literature. A meta-analysis of studies meeting inclusion criteria shows mean incidences of PISVT of 14.1% in all patients, 22.6% in patients with AP and 12.4% in patients with CP. The incidence of associated splenomegaly was only 51.9% in these patients. Varices were identified in 53.0% of patients and were gastric in 77.3% of cases. The overall rate of GI bleeding was 12.3%. Conclusions: Although reported incidences of PISVT vary widely across studies, an overall incidence of 14.1% is reported. Splenomegaly is an unreliable sign of PISVT. Although the true natural history of PISVT remains unknown, the collective reported rate of associated GI bleeding is 12.3%.

Original languageEnglish
Pages (from-to)839-845
Number of pages7
JournalHPB
Volume13
Issue number12
DOIs
StatePublished - Dec 2011

Fingerprint

Splenic Vein
Pancreatitis
Meta-Analysis
Thrombosis
Hemorrhage
Incidence
Splenomegaly
Chronic Pancreatitis
Databases
Varicose Veins
Natural History
MEDLINE
Stomach
Decision Making
Cohort Studies
Clinical Trials
Confidence Intervals

Keywords

  • acute pancreatitis
  • chronic pancreatitis
  • gastric varices
  • gastrointestinal bleeding
  • left-sided portal hypertension
  • sinistral hypertension
  • splenic vein thrombosis

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Natural history of pancreatitis-induced splenic vein thrombosis : A systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. / Butler, James R.; Eckert, George J.; Zyromski, Nicholas; Leonardi, Michael J.; Lillemoe, Keith D.; Howard, Thomas.

In: HPB, Vol. 13, No. 12, 12.2011, p. 839-845.

Research output: Contribution to journalArticle

@article{25e933d657514449ab13eb661eb43b04,
title = "Natural history of pancreatitis-induced splenic vein thrombosis: A systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding",
abstract = "Background: Pancreatitis-induced splenic vein thrombosis (PISVT) is an acquired anatomic abnormality that impacts decision making in pancreatic surgery. Despite this influence, its incidence and the rate of associated gastrointestinal (GI) bleeding are imprecisely known. Methods: The MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials and Cochrane Database of Systematic Reviews databases were searched from their inception to June 2010 for abstracts documenting PISVT in acute (AP) or chronic pancreatitis (CP). Two reviewers independently graded abstracts for inclusion in this review. Heterogeneity in combining data was assumed prior to pooling. Random-effects meta-analyses were performed to estimate percentages and 95{\%} confidence intervals. Results: After review of 241 abstracts, 47 studies and 52 case reports were graded as relevant. These represent a cohort of 805 patients with PISVT reported in the literature. A meta-analysis of studies meeting inclusion criteria shows mean incidences of PISVT of 14.1{\%} in all patients, 22.6{\%} in patients with AP and 12.4{\%} in patients with CP. The incidence of associated splenomegaly was only 51.9{\%} in these patients. Varices were identified in 53.0{\%} of patients and were gastric in 77.3{\%} of cases. The overall rate of GI bleeding was 12.3{\%}. Conclusions: Although reported incidences of PISVT vary widely across studies, an overall incidence of 14.1{\%} is reported. Splenomegaly is an unreliable sign of PISVT. Although the true natural history of PISVT remains unknown, the collective reported rate of associated GI bleeding is 12.3{\%}.",
keywords = "acute pancreatitis, chronic pancreatitis, gastric varices, gastrointestinal bleeding, left-sided portal hypertension, sinistral hypertension, splenic vein thrombosis",
author = "Butler, {James R.} and Eckert, {George J.} and Nicholas Zyromski and Leonardi, {Michael J.} and Lillemoe, {Keith D.} and Thomas Howard",
year = "2011",
month = "12",
doi = "10.1111/j.1477-2574.2011.00375.x",
language = "English",
volume = "13",
pages = "839--845",
journal = "HPB",
issn = "1365-182X",
publisher = "John Wiley and Sons Inc.",
number = "12",

}

TY - JOUR

T1 - Natural history of pancreatitis-induced splenic vein thrombosis

T2 - A systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding

AU - Butler, James R.

AU - Eckert, George J.

AU - Zyromski, Nicholas

AU - Leonardi, Michael J.

AU - Lillemoe, Keith D.

AU - Howard, Thomas

PY - 2011/12

Y1 - 2011/12

N2 - Background: Pancreatitis-induced splenic vein thrombosis (PISVT) is an acquired anatomic abnormality that impacts decision making in pancreatic surgery. Despite this influence, its incidence and the rate of associated gastrointestinal (GI) bleeding are imprecisely known. Methods: The MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials and Cochrane Database of Systematic Reviews databases were searched from their inception to June 2010 for abstracts documenting PISVT in acute (AP) or chronic pancreatitis (CP). Two reviewers independently graded abstracts for inclusion in this review. Heterogeneity in combining data was assumed prior to pooling. Random-effects meta-analyses were performed to estimate percentages and 95% confidence intervals. Results: After review of 241 abstracts, 47 studies and 52 case reports were graded as relevant. These represent a cohort of 805 patients with PISVT reported in the literature. A meta-analysis of studies meeting inclusion criteria shows mean incidences of PISVT of 14.1% in all patients, 22.6% in patients with AP and 12.4% in patients with CP. The incidence of associated splenomegaly was only 51.9% in these patients. Varices were identified in 53.0% of patients and were gastric in 77.3% of cases. The overall rate of GI bleeding was 12.3%. Conclusions: Although reported incidences of PISVT vary widely across studies, an overall incidence of 14.1% is reported. Splenomegaly is an unreliable sign of PISVT. Although the true natural history of PISVT remains unknown, the collective reported rate of associated GI bleeding is 12.3%.

AB - Background: Pancreatitis-induced splenic vein thrombosis (PISVT) is an acquired anatomic abnormality that impacts decision making in pancreatic surgery. Despite this influence, its incidence and the rate of associated gastrointestinal (GI) bleeding are imprecisely known. Methods: The MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials and Cochrane Database of Systematic Reviews databases were searched from their inception to June 2010 for abstracts documenting PISVT in acute (AP) or chronic pancreatitis (CP). Two reviewers independently graded abstracts for inclusion in this review. Heterogeneity in combining data was assumed prior to pooling. Random-effects meta-analyses were performed to estimate percentages and 95% confidence intervals. Results: After review of 241 abstracts, 47 studies and 52 case reports were graded as relevant. These represent a cohort of 805 patients with PISVT reported in the literature. A meta-analysis of studies meeting inclusion criteria shows mean incidences of PISVT of 14.1% in all patients, 22.6% in patients with AP and 12.4% in patients with CP. The incidence of associated splenomegaly was only 51.9% in these patients. Varices were identified in 53.0% of patients and were gastric in 77.3% of cases. The overall rate of GI bleeding was 12.3%. Conclusions: Although reported incidences of PISVT vary widely across studies, an overall incidence of 14.1% is reported. Splenomegaly is an unreliable sign of PISVT. Although the true natural history of PISVT remains unknown, the collective reported rate of associated GI bleeding is 12.3%.

KW - acute pancreatitis

KW - chronic pancreatitis

KW - gastric varices

KW - gastrointestinal bleeding

KW - left-sided portal hypertension

KW - sinistral hypertension

KW - splenic vein thrombosis

UR - http://www.scopus.com/inward/record.url?scp=81255160983&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=81255160983&partnerID=8YFLogxK

U2 - 10.1111/j.1477-2574.2011.00375.x

DO - 10.1111/j.1477-2574.2011.00375.x

M3 - Article

VL - 13

SP - 839

EP - 845

JO - HPB

JF - HPB

SN - 1365-182X

IS - 12

ER -