Portal vein thrombosis in patients with hepatosplenic schistosomiasis who underwent oesophagogastric devascularization combined with splenectomy

Abstract

Background Portal vein thrombosis (PVT) has been described in nearly 50% of patients who underwent oesophagogastric devascularization combined with splenectomy (EGDS), but no previous study has compared its occurrence in surgical and non-surgical groups. This study aimed to investigate PVT in hepatosplenic schistosomiasis (HSS) and its association with EGDS and upper variceal bleeding (UVB). Methods Retrospectively, 104 HSS individuals were enrolled. Following EGDS, the occurrence of PVT, mesenteric vein thrombosis (MVT), hospital admissions and UVB were recorded. Results EGDS was performed in 27 (26%) patients. PVT and MVT were detected in 30 (33%) and 8 (9.8%) patients, respectively. Patients who underwent EGDS were at greater risk of PVT (63% vs 19.7%; odds ratio [OR] 6.12 [95% confidence interval {CI} 2.3 to 16.1], p<0.001) when compared with a non-surgical approach. There was no significant difference in UVB occurrence and β-blocker usage. PVT was associated with more hospital admissions (p=0.030) and higher alkaline phosphatase levels (p=0.008). UVB occurrence in patients with and without thrombosis was similar. In multivariate analysis, after adjustment, PVT was associated with the surgical approach (OR 4.56 [95% CI 1.55 to 13.38], p=0.006) and age at HSS diagnosis (OR 0.94 [95% CI 0.90 to 0.99], p=0.021). Conclusions EGDS was not associated with a decreased frequency of UVB when compared with the non-surgical approach but was an independent risk factor for PVT.

Portal thrombosis after surgical treatment of schistosomatic portal hypertension

“…No drugs, such as heparins, salicylic acid, or other ­antithrombotics, have proven effective in preventing or treating specific ­portal ­thrombosis. All drugs have been prescribed based on their systemic effects, which differ from their effects on the ­portal system 10 , 11 . Considering that portal thrombi are transient and self-limited, the presumed efficacy of these drugs may not align with reality 4 , 5 , 11 .…”

“…The patients were distributed into four groups based on the four surgical procedures recommended in the ­literature for ­treating portal hypertension without ­vascular shunt 4 - 7 , 11 , 16 ( Figure 1 ):…”

“…Although the splenoportal thrombus may extend to other veins, such as the superior and inferior mesenteric veins and the left gastric vein, no motility or absorptive or metabolic digestive disorders have been associated with this event. Mesenteric ­ischemia with intestinal necrosis occurs in less than 1% of all cases 10 , 11 .…”

Hepatosplenic Schistosomiasis-Associated Chronic Portal Vein Thrombosis: Risk Factor for Hepatocellular Carcinoma?

“…Schistosomiasis is associated with a higher incidence of PVT in up to 33% of patients 4 . Potential mechanisms are vascular alterations and endothelial injury in presinusoidal medium-sized portal system branches due to periportal fibrosis and portal hypertension 3 , 20 .…”

“…The reported incidence of PVT in HSS patients is 33% 6 . A high incidence ranging from 17–63% is observed in patients undergoing splenectomy 4 , 6 , 9 , 19 , with a 6.12-fold higher risk 4 . PVT can further accentuate portal hypertension with complications, such as GI bleeding due to varices, ascites, portal biliopathy, and portosystemic encephalopathy 16 .…”