Venous Thromboembolism in Necrotizing Pancreatitis: an Underappreciated Risk

Roch, Alexandra M.; Maatman, Thomas K.; Carr, Rose A.; Colgate, Cameron L.; Ceppa, Eugene P.; House, Michael G.; Lopes, James; Nakeeb, Attila; Schmidt, C. Max; Zyromski, Nicholas J.

doi:10.1007/s11605-019-04124-0

Cited by 41 publications

(37 citation statements)

References 23 publications

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“…33 SVT was diagnosed on contrast enhanced cross-sectional imaging in the presence of a filling defect within the lumen of the portal vein, superior mesenteric vein, and/or splenic vein. 34 Radiographic evidence of presinusoidal portal hypertension in patients with SVT included esophageal or gastric varices with collateral vessel development. Pancreatic duct stricture was diagnosed on ERP or MRP as a localized narrowing of the pancreatic duct measuring ˂5 mm in length.…”

Section: Definitionsmentioning

confidence: 99%

“…The impact of venous thromboembolism, including SVT, deep vein thrombosis, and pulmonary embolism on outcomes during acute NP have been reported elsewhere. 34 Pancreaticobiliary and duodenal stricture Pancreatic duct stricture developed in 5% of patients (30 of 578 patients) and was diagnosed at a median of 18 months (range, 2 Biliary stricture developed in 16% of patients (90 of 576 patients), presenting a median of 12 months (range, 14 days to 10 years) after the onset of NP. At presentation, the mean alkaline phosphatase was 557 ± 65 U/L and the mean total bilirubin was 4.3 ± 0.5 mg/dL.…”

Section: Splanchnic Vein Thrombosismentioning

confidence: 99%

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The continuum of complications in survivors of necrotizing pancreatitis

Maatman

Roch

Ceppa

et al. 2020

Surgery

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Background: Necrotizing pancreatitis survivors develop complications beyond infected necrosis that often require invasive intervention. Remarkably few data have cataloged these late complications after acute necrotizing pancreatitis resolution. We sought to identify the types and incidence of complications after necrotizing pancreatitis. Design: An observational study was performed evaluating 647 patients with necrotizing pancreatitis captured in a single-institution database between 2005 and 2017 at a tertiary care hospital. Retrospective review and analysis of newly diagnosed conditions attributable to necrotizing pancreatitis was performed. Exclusion criteria included the following: death before disease resolution (n ¼ 57, 9%) and patients lost to follow-up (n ¼ 12, 2%). Results: A total of 578 patients were followed for a median of 46 months (range, 8 months to 15 y) after necrotizing pancreatitis. In 489 (85%) patients 1 or more complications developed and included symptomatic disconnected pancreatic duct syndrome (285 of 578, 49%), splanchnic vein thrombosis (257 of 572, 45%), new endocrine insufficiency (195 of 549, 35%), new exocrine insufficiency (108 of 571, 19%), symptomatic chronic pancreatitis (93 of 571, 16%), incisional hernia (89 of 420, 21%), biliary stricture (90 of 576, 16%), chronic pain (44 of 575, 8%), gastrointestinal fistula (44 of 578, 8%), pancreatic duct stricture (30 of 578, 5%), and duodenal stricture (28 of 578, 5%). During the follow-up period, a total of 340 (59%) patients required an invasive intervention after necrotizing pancreatitis resolution. Invasive pancreatobiliary intervention was required in 230 (40%) patients. Conclusion: Late complications are common in necrotizing pancreatitis survivors. A broad variety of problems manifest themselves after resolution of the acute disease process and often require invasive intervention. Necrotizing pancreatitis patients should be followed lifelong by experienced clinicians.

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Section: Definitionsmentioning

confidence: 99%

Section: Splanchnic Vein Thrombosismentioning

confidence: 99%

The continuum of complications in survivors of necrotizing pancreatitis

Maatman

Roch

Ceppa

et al. 2020

Surgery

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“…Profound systemic inflammation, critical illness, immobility, and organ failure are documented risk factors for a prothrombotic and hypercoagulable state (16)(17)(18). Recent autopsy reports in patients with COVID-19 identified cardiac and pulmonary microvascular thrombosis (19), supporting clinical suspicion for this pathophysiologic mechanism in COVID-19 shared among physicians on preprint platforms and social media.…”

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confidence: 99%

Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019

Maatman

Jalali

Feizpour

et al. 2020

Critical Care Medicine

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“…About one fourth of the patients developed variable symptomatic manifestations including gastrointestinal bleeding, persistent ascites, oral intake intolerance and even hepatic infarction [21,22]. In addition to SVT or PSVT, other venous thromboembolism(VTE) in necrotizing pancreatitis, including extremity deep venous thrombosis and pulmonary embolism was also common with the incidence of 16% and 6%,respectively [23]. Previous study showed male gender, history of previous deep venous thrombosis, infected necrosis, development of organ failure, and development of respiratory failure were identi ed as risk factors for VTE [23].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to SVT or PSVT, other venous thromboembolism(VTE) in necrotizing pancreatitis, including extremity deep venous thrombosis and pulmonary embolism was also common with the incidence of 16% and 6%,respectively [23]. Previous study showed male gender, history of previous deep venous thrombosis, infected necrosis, development of organ failure, and development of respiratory failure were identi ed as risk factors for VTE [23]. Recent systemic review demonstrated that about 46.5% patients received anticoagulation therapy, However, rates of recanalization of veins in the treated and non-treated groups were comparable [24].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Transgastric Necrosectomy in Treatment of Walled-off Pancreatic Necrosis with Sinistral Portal Hypertension: A Single-Center Retrospectively Study

Feng

Zheng

et al. 2020

Preprint

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Background: Laparoscopic transgastric necrosectomy (LTGN) has been used in treatment of walled-off pancreatic necrosis (WON) for more than a decade. However, the safety and effectiveness of LTGN for WON with sinistral portal hypertension was still unclear. Methods: WON patients with sinistral portal hypertension treated in our department between Jan. 2011 and Dec. 2018 were included and retrospective analyzed in this study. Patients were divided into two groups according to different surgical approaches, LTNG or laparoscopic assisted trans-lesser sac necrosectomy (LATLSN). Perioperative and long-term outcomes were compared between two groups. Results: 312 cases diagnosed with WON were screened and 53 were finally included in this study. Of the included patients, 21 and 32 cases were received LTGN and LATLSN, respectively. LTGN was associated with significantly lower morbidity than LATLSN (19.0% vs 46.9%, p=0.04) and similar sever complication (Clavien-Dindo≥Ⅲ) rate (12.5% vs 19.0%, p=0.70). LTGN did not increase the rate of postoperative hemorrhage (9.5% vs 6.3%, p=1.00) and mortality (9.5% vs 9.4%, p=1.00). After 39(11-108) months follow-up, the recurrence rate of WON and long-term complications were also comparable between groups. Conclusions: From current data, LTGN was safe and effective in treatment of WON patients with sinistral portal hypertension in terms of short- and long-term outcomes.

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Venous Thromboembolism in Necrotizing Pancreatitis: an Underappreciated Risk

Cited by 41 publications

References 23 publications

The continuum of complications in survivors of necrotizing pancreatitis

The continuum of complications in survivors of necrotizing pancreatitis

Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019

Laparoscopic Transgastric Necrosectomy in Treatment of Walled-off Pancreatic Necrosis with Sinistral Portal Hypertension: A Single-Center Retrospectively Study

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