Advances in diagnosis and treatment of pancreatic portal hypertension_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaobing ¹ , MAO Qingsong ² ,  GONG Jianping ²

1. Department of General Surgery (Gastrointestinal Surgery), People’s Hospital of Yubei District in Chongqing, Chongqing 401120, P. R. China;
2. Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding?author：

GONG Jianping, Email: gongjianping11@126.com

Keywords：

pancreatic portal hypertension; pancreatitis; pancreatic tumor; diagnosis; treatment; review

DOI：

10.7507/1007-9424.202203022

Video：

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Objective To summarize the related researches of pancreatic portal hypertension (PPH) in recent years in order to diagnose and treat the disease more timely and effectively. Method The literatures relevant to etiology, mechanism, clinical features, diagnostic criteria, and treatment of PPH were searched and reviewed. Results The occurrence of PPH was related to its anatomical structure. Its clinical manifestations were not characteristic, but it was not difficult to diagnose by the assistance of auxiliary examinations. The treatment of PPH was mainly targeted at pancreatic diseases and portal hypertension, and the treatment targeted at portal hypertension was performed according to the situation with or without gastrointestinal bleeding. So, in clinical practice, different treatment measures should be taken according to different situations. Conclusion At present, the clinical diagnosis and treatment of PPH is relatively mature, but its preventive treatment is still controversial, which will be the focus of future research.

Citation： WANG Xiaobing, MAO Qingsong, GONG Jianping. Advances in diagnosis and treatment of pancreatic portal hypertension. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(9): 1250-1255. doi: 10.7507/1007-9424.202203022 Copy

1.	杜奕奇, 宋英曉. 胰源性門靜脈高壓的診斷與處理. 中華消化雜志, 2020, 40(7): 450-453.
2.	McIntyre B, Marsh M, Walden J. Puzzles in practice: splenic vein thrombosis. Postgrad Med, 2016, 128(5): 538-540.
3.	時宇, 潘萌, 聶深鈺, 等. 胰源性門脈高壓癥238例. 中國老年學雜志, 2015, 35(17): 5000-5001.
4.	Ru N, He CH, Ren XL, et al. Risk factors for sinistral portal hypertension and related variceal bleeding in patients with chronic pancreatitis. J Dig Dis, 2020, 21(8): 468-474.
5.	Xie CL, Zhang M, Chen Y, et al. Spleen and splenic vascular involvement in acute pancreatitis: an MRI study. Quant Imaging Med Surg, 2018, 8(3): 291-300.
6.	Pandey V, Patil M, Patel R, et al. Prevalence of splenic vein thrombosis and risk of gastrointestinal bleeding in chronic pancreatitis patients attending a tertiary hospital in western India. J Family Med Prim Care, 2019, 8(3): 818-822.
7.	Sheets SSF. Pancreas cancer. https://seer.cancer.gov/statfacts/html/pancreas. html. Accessed 5/14/2022.
8.	Saif MW, Kaley K, Lamb L. Pancreatic adenocarcinoma complicated by sinistral portal hypertension. Cureus, 2016, 8(7): e689. doi: 10.7759/cureus.689.
9.	Qi X, Feng J, Shao X, et al. Portal hypertension in a patient with recurrent pancreatic cancer after radiotherapy and systemic chemotherapy. J Clin Exp Hepatol, 2018, 8(1): 106-108.
10.	Yu D, Li X, Gong J, et al. Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review. BMC Gastroenterol, 2020, 20(1): 276. doi: 10.1186/s12876-020-01420-x.
11.	Ono Y, Inoue Y, Kato T, et al. Sinistral portal hypertension after pancreaticoduodenectomy with splenic vein resection: pathogenesis and its prevention. Cancers (Basel), 2021, 13(21): 5334. doi: 10.3390/cancers13215334.
12.	周稼, 苗毅, 喻春釗. 胰源性門靜脈高壓癥研究現狀. 臨床外科雜志, 2018, 26(5): 393-395.
13.	Harbell JW, Morgan T, Feldstein VA, et al. Splenic vein thrombosis following pancreas transplantation: identification of factors that support conservative management. Am J Transplant, 2017, 17(11): 2955-2962.
14.	Mizuno S, Kato H, Yamaue H, et al. Left-sided portal hypertension after pancreaticoduodenectomy with resection of the portal vein/superior mesenteric vein confluence in patients with pancreatic cancer: a project study by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Ann Surg, 2021, 274(1): e36-e44. doi: 10.1097/SLA.0000000000003487.
15.	Li H, Yang Z, Tian F. Clinical characteristics and risk factors for sinistral portal hypertension associated with moderate and severe acute pancreatitis: a seven-year single-center retrospective study. Med Sci Monit, 2019, 25: 5969-5976.
16.	呂新建, 孔瑞, 孫備. 胰源性門靜脈高壓癥的外科治療現狀. 中華肝臟外科手術學電子雜志, 2017, 6(4): 245-247.
17.	Hoilat GJ, Katta S. Pancreatic abscess//StatPearls [Internet]. 2021 Nov 7. Treasure Island (FL): StatPearls Publishing, 2022. PMID: 32809390.
18.	Pereira P, Peixoto A. Left-sided portal hypertension: a clinical challenge. GE Port J Gastroenterol, 2015, 22(6): 231-233.
19.	Wang L, Liu GJ, Chen YX, et al. Sinistral portal hypertension: clinical features and surgical treatment of chronic splenic vein occlusion. Med Princ Pract, 2012, 21(1): 20-23.
20.	Primignani M. Pancreatitis-related splanchnic vein thrombosis: what role, what warnings for anticoagulation therapy? J Dig Dis, 2021, 22(3): 122-125.
21.	Sato K, Sakamoto Y, Sakai M, et al. Diagnostic utility of computed tomographic angiography in dogs with portal vein thrombosis. J Vet Med Sci, 2020, 82(10): 1421-1427.
22.	Nikolić M, Boban M, Ljubicić N, et al. Evaluation of upper gastrointestinal submucosal lesions by endoscopic ultrasonography. Acta Med Croatica, 2009, 63 Suppl 3: 29-37.
23.	Leger L, Lenriot JP, Lemaigre G. Hypertension and segmental portal stasis in chronic pancreatitis. Apropos of 126 cases examined by splenoportography and splenomanometry. J Chir (Paris), 1968, 95(5): 599-608.
24.	李非, 曹鋒. 中國急性胰腺炎診治指南(2021). 中國實用外科雜志, 2021, 41(7): 739-746.
25.	Misra D, Sood T. Pancreatic pseudocyst//StatPearls [Internet]. 2021 Aug 11. Treasure Island (FL): StatPearls Publishing, 2022. PMID: 32491526.
26.	Panic N, Maetzel H, Bulajic M, et al. Pancreatic tuberculosis: a systematic review of symptoms, diagnosis and treatment. United European Gastroenterol J, 2020, 8(4): 396-402.
27.	Bronswijk M, Persyn D, Caenepeel P, et al. Treatment of an impacted pancreatic duct stone by snare-assisted stone extraction and pancreatoscopy-guided lithotripsy. Endoscopy. 2021 Jul 19. doi: 10.1055/a-1540-6319.
28.	Ilic M, Ilic I. Epidemiology of pancreatic cancer. World J Gastroenterol, 2016, 22(44): 9694-9705.
29.	McGuigan A, Kelly P, Turkington RC, et al. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol, 2018, 24(43): 4846-4861.
30.	Zakeri S, Gorji N, Akhtari M, et al. Splenectomy may have more complications than currently proven. Med Hypotheses, 2018, 112: 43-46.
31.	Matsui T, Nagai H, Amanuma M, et al. Usefulness of partial splenic embolization for left-sided portal hypertension in a patient with a pancreatic neuroendocrine neoplasm: a case report and review of the literature. Clin J Gastroenterol. 2022 Apr 16. doi: 10.1007/s12328-022-01631-7.
32.	朱衛華, 謝文勇, 張哲棟, 等. 胰源性區域性門靜脈高壓致上消化道出血診治分析. 中華普通外科雜志, 2019, 34(3): 193-195.
33.	雷澤華, 高峰畏, 趙欣, 等. 胰源性門靜脈高壓癥手術時機及手術方式的探討. 中華普通外科雜志, 2018, 33(7): 556-558.
34.	張曉君, 周敏, 張軍, 等. 原位脾切除聯合選擇性賁門周圍血管離斷術治療門靜脈高壓癥. 中華普通外科雜志, 2016, 31(10): 801-803.
35.	李文斌, 朱朝庚, 向興華, 等. 胰源性門靜脈高壓癥的診斷和外科治療: 附20例報告. 中國普通外科雜志, 2021, 30(3): 365-368.
36.	Liu J, Wang Q, Ding X, et al. The clinical applicability of percutaneous splenic vein stent implantation for pancreatic portal hypertension. BMC Gastroenterol, 2022, 22(1): 136. doi: 10.1186/s12876-022-02214-z.
37.	朱軍, 徐曉茜, 羅劍鈞, 等. 經皮脾靜脈成形術治療胰源性門靜脈高壓癥. 介入放射學雜志, 2018, 27(5): 415-418.
38.	Wei B, Zhang L, Tong H, et al. Retrospective comparison of clinical outcomes following splenic vein stenting and splenic arterial embolization in sinistral portal hypertension-related gastrointestinal bleeding. AJR Am J Roentgenol, 2021, 216(6): 1579-1587.
39.	Wang Q, Xiong B, Zheng C, et al. Splenic arterial embolization in the treatment of severe portal hypertension due to pancreatic diseases: the primary experience in 14 patients. Cardiovasc Intervent Radiol, 2016, 39(3): 353-358.
40.	Liu J, Meng J, Yang M, et al. Two-step complete splenic artery embolization for the management of symptomatic sinistral portal hypertension. Scand J Gastroenterol, 2022, 57(1): 78-84.
41.	Wang Z, Li M, Huang X, et al. Preoperative splenic artery embolism followed by splenectomy is safe and effective in patients with sinistral portal hypertension. Langenbecks Arch Surg, 2022, 407(1): 313-319.
42.	Hong JA, Liu CA, Lee RC, et al. Unusual case of left-sided portal hypertension induced variceal bleeding after pancreaticoduodenectomy treated with transplenic embolization. Radiol Case Rep. 2021 Jun 8;16(8): 2061-2064.
43.	周光文, 關蛟, 靳勇. 胰源性門靜脈高壓癥的診治進展. 中華肝膽外科雜志, 2017, 23(1): 1-4.
44.	李兆申, 郭洪雷. 胰源性門脈高壓癥的診治進展. 肝膽外科雜志, 2017, 25(5): 325-328.
45.	Easler J, Muddana V, Furlan A, et al. Portosplenomesenteric venous thrombosis in patients with acute pancreatitis is associated with pancreatic necrosis and usually has a benign course. Clin Gastroenterol Hepatol, 2014, 12(5): 854-862.
46.	Xu W, Qi X, Chen J, et al. Prevalence of splanchnic vein thrombosis in pancreatitis: a systematic review and meta-analysis of observational studies. Gastroenterol Res Pract, 2015, 2015: 245460. doi: 10.1155/2015/245460.
47.	Naymagon L, Tremblay D, Zubizarreta N, et al. The efficacy and safety of direct oral anticoagulants in noncirrhotic portal vein thrombosis. Blood Adv, 2020, 4(4): 655-666.
48.	Pancreas Study Group, Chinese Society of Gastroenterology, Chinese Medical Association. Practice guidance for diagnosis and treatment of pancreatitis-related splanchnic vein thrombosis (Shenyang, 2020). J Dig Dis, 2021, 22(1): 2-8.
49.	Addeo P, De Mathelin P, Averous G, et al. The left splenorenal venous shunt decreases clinical signs of sinistral portal hypertension associated with splenic vein ligation during pancreaticoduodenectomy with venous resection. Surgery, 2020, 168(2): 267-273.

1. 杜奕奇, 宋英曉. 胰源性門靜脈高壓的診斷與處理. 中華消化雜志, 2020, 40(7): 450-453.
2. McIntyre B, Marsh M, Walden J. Puzzles in practice: splenic vein thrombosis. Postgrad Med, 2016, 128(5): 538-540.
3. 時宇, 潘萌, 聶深鈺, 等. 胰源性門脈高壓癥238例. 中國老年學雜志, 2015, 35(17): 5000-5001.
4. Ru N, He CH, Ren XL, et al. Risk factors for sinistral portal hypertension and related variceal bleeding in patients with chronic pancreatitis. J Dig Dis, 2020, 21(8): 468-474.
5. Xie CL, Zhang M, Chen Y, et al. Spleen and splenic vascular involvement in acute pancreatitis: an MRI study. Quant Imaging Med Surg, 2018, 8(3): 291-300.
6. Pandey V, Patil M, Patel R, et al. Prevalence of splenic vein thrombosis and risk of gastrointestinal bleeding in chronic pancreatitis patients attending a tertiary hospital in western India. J Family Med Prim Care, 2019, 8(3): 818-822.
7. Sheets SSF. Pancreas cancer. https://seer.cancer.gov/statfacts/html/pancreas. html. Accessed 5/14/2022.
8. Saif MW, Kaley K, Lamb L. Pancreatic adenocarcinoma complicated by sinistral portal hypertension. Cureus, 2016, 8(7): e689. doi: 10.7759/cureus.689.
9. Qi X, Feng J, Shao X, et al. Portal hypertension in a patient with recurrent pancreatic cancer after radiotherapy and systemic chemotherapy. J Clin Exp Hepatol, 2018, 8(1): 106-108.
10. Yu D, Li X, Gong J, et al. Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review. BMC Gastroenterol, 2020, 20(1): 276. doi: 10.1186/s12876-020-01420-x.
11. Ono Y, Inoue Y, Kato T, et al. Sinistral portal hypertension after pancreaticoduodenectomy with splenic vein resection: pathogenesis and its prevention. Cancers (Basel), 2021, 13(21): 5334. doi: 10.3390/cancers13215334.
12. 周稼, 苗毅, 喻春釗. 胰源性門靜脈高壓癥研究現狀. 臨床外科雜志, 2018, 26(5): 393-395.
13. Harbell JW, Morgan T, Feldstein VA, et al. Splenic vein thrombosis following pancreas transplantation: identification of factors that support conservative management. Am J Transplant, 2017, 17(11): 2955-2962.
14. Mizuno S, Kato H, Yamaue H, et al. Left-sided portal hypertension after pancreaticoduodenectomy with resection of the portal vein/superior mesenteric vein confluence in patients with pancreatic cancer: a project study by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Ann Surg, 2021, 274(1): e36-e44. doi: 10.1097/SLA.0000000000003487.
15. Li H, Yang Z, Tian F. Clinical characteristics and risk factors for sinistral portal hypertension associated with moderate and severe acute pancreatitis: a seven-year single-center retrospective study. Med Sci Monit, 2019, 25: 5969-5976.
16. 呂新建, 孔瑞, 孫備. 胰源性門靜脈高壓癥的外科治療現狀. 中華肝臟外科手術學電子雜志, 2017, 6(4): 245-247.
17. Hoilat GJ, Katta S. Pancreatic abscess//StatPearls [Internet]. 2021 Nov 7. Treasure Island (FL): StatPearls Publishing, 2022. PMID: 32809390.
18. Pereira P, Peixoto A. Left-sided portal hypertension: a clinical challenge. GE Port J Gastroenterol, 2015, 22(6): 231-233.
19. Wang L, Liu GJ, Chen YX, et al. Sinistral portal hypertension: clinical features and surgical treatment of chronic splenic vein occlusion. Med Princ Pract, 2012, 21(1): 20-23.
20. Primignani M. Pancreatitis-related splanchnic vein thrombosis: what role, what warnings for anticoagulation therapy? J Dig Dis, 2021, 22(3): 122-125.
21. Sato K, Sakamoto Y, Sakai M, et al. Diagnostic utility of computed tomographic angiography in dogs with portal vein thrombosis. J Vet Med Sci, 2020, 82(10): 1421-1427.
22. Nikolić M, Boban M, Ljubicić N, et al. Evaluation of upper gastrointestinal submucosal lesions by endoscopic ultrasonography. Acta Med Croatica, 2009, 63 Suppl 3: 29-37.
23. Leger L, Lenriot JP, Lemaigre G. Hypertension and segmental portal stasis in chronic pancreatitis. Apropos of 126 cases examined by splenoportography and splenomanometry. J Chir (Paris), 1968, 95(5): 599-608.
24. 李非, 曹鋒. 中國急性胰腺炎診治指南(2021). 中國實用外科雜志, 2021, 41(7): 739-746.
25. Misra D, Sood T. Pancreatic pseudocyst//StatPearls [Internet]. 2021 Aug 11. Treasure Island (FL): StatPearls Publishing, 2022. PMID: 32491526.
26. Panic N, Maetzel H, Bulajic M, et al. Pancreatic tuberculosis: a systematic review of symptoms, diagnosis and treatment. United European Gastroenterol J, 2020, 8(4): 396-402.
27. Bronswijk M, Persyn D, Caenepeel P, et al. Treatment of an impacted pancreatic duct stone by snare-assisted stone extraction and pancreatoscopy-guided lithotripsy. Endoscopy. 2021 Jul 19. doi: 10.1055/a-1540-6319.
28. Ilic M, Ilic I. Epidemiology of pancreatic cancer. World J Gastroenterol, 2016, 22(44): 9694-9705.
29. McGuigan A, Kelly P, Turkington RC, et al. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol, 2018, 24(43): 4846-4861.
30. Zakeri S, Gorji N, Akhtari M, et al. Splenectomy may have more complications than currently proven. Med Hypotheses, 2018, 112: 43-46.
31. Matsui T, Nagai H, Amanuma M, et al. Usefulness of partial splenic embolization for left-sided portal hypertension in a patient with a pancreatic neuroendocrine neoplasm: a case report and review of the literature. Clin J Gastroenterol. 2022 Apr 16. doi: 10.1007/s12328-022-01631-7.
32. 朱衛華, 謝文勇, 張哲棟, 等. 胰源性區域性門靜脈高壓致上消化道出血診治分析. 中華普通外科雜志, 2019, 34(3): 193-195.
33. 雷澤華, 高峰畏, 趙欣, 等. 胰源性門靜脈高壓癥手術時機及手術方式的探討. 中華普通外科雜志, 2018, 33(7): 556-558.
34. 張曉君, 周敏, 張軍, 等. 原位脾切除聯合選擇性賁門周圍血管離斷術治療門靜脈高壓癥. 中華普通外科雜志, 2016, 31(10): 801-803.
35. 李文斌, 朱朝庚, 向興華, 等. 胰源性門靜脈高壓癥的診斷和外科治療: 附20例報告. 中國普通外科雜志, 2021, 30(3): 365-368.
36. Liu J, Wang Q, Ding X, et al. The clinical applicability of percutaneous splenic vein stent implantation for pancreatic portal hypertension. BMC Gastroenterol, 2022, 22(1): 136. doi: 10.1186/s12876-022-02214-z.
37. 朱軍, 徐曉茜, 羅劍鈞, 等. 經皮脾靜脈成形術治療胰源性門靜脈高壓癥. 介入放射學雜志, 2018, 27(5): 415-418.
38. Wei B, Zhang L, Tong H, et al. Retrospective comparison of clinical outcomes following splenic vein stenting and splenic arterial embolization in sinistral portal hypertension-related gastrointestinal bleeding. AJR Am J Roentgenol, 2021, 216(6): 1579-1587.
39. Wang Q, Xiong B, Zheng C, et al. Splenic arterial embolization in the treatment of severe portal hypertension due to pancreatic diseases: the primary experience in 14 patients. Cardiovasc Intervent Radiol, 2016, 39(3): 353-358.
40. Liu J, Meng J, Yang M, et al. Two-step complete splenic artery embolization for the management of symptomatic sinistral portal hypertension. Scand J Gastroenterol, 2022, 57(1): 78-84.
41. Wang Z, Li M, Huang X, et al. Preoperative splenic artery embolism followed by splenectomy is safe and effective in patients with sinistral portal hypertension. Langenbecks Arch Surg, 2022, 407(1): 313-319.
42. Hong JA, Liu CA, Lee RC, et al. Unusual case of left-sided portal hypertension induced variceal bleeding after pancreaticoduodenectomy treated with transplenic embolization. Radiol Case Rep. 2021 Jun 8;16(8): 2061-2064.
43. 周光文, 關蛟, 靳勇. 胰源性門靜脈高壓癥的診治進展. 中華肝膽外科雜志, 2017, 23(1): 1-4.
44. 李兆申, 郭洪雷. 胰源性門脈高壓癥的診治進展. 肝膽外科雜志, 2017, 25(5): 325-328.
45. Easler J, Muddana V, Furlan A, et al. Portosplenomesenteric venous thrombosis in patients with acute pancreatitis is associated with pancreatic necrosis and usually has a benign course. Clin Gastroenterol Hepatol, 2014, 12(5): 854-862.
46. Xu W, Qi X, Chen J, et al. Prevalence of splanchnic vein thrombosis in pancreatitis: a systematic review and meta-analysis of observational studies. Gastroenterol Res Pract, 2015, 2015: 245460. doi: 10.1155/2015/245460.
47. Naymagon L, Tremblay D, Zubizarreta N, et al. The efficacy and safety of direct oral anticoagulants in noncirrhotic portal vein thrombosis. Blood Adv, 2020, 4(4): 655-666.
48. Pancreas Study Group, Chinese Society of Gastroenterology, Chinese Medical Association. Practice guidance for diagnosis and treatment of pancreatitis-related splanchnic vein thrombosis (Shenyang, 2020). J Dig Dis, 2021, 22(1): 2-8.
49. Addeo P, De Mathelin P, Averous G, et al. The left splenorenal venous shunt decreases clinical signs of sinistral portal hypertension associated with splenic vein ligation during pancreaticoduodenectomy with venous resection. Surgery, 2020, 168(2): 267-273.

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Advances in diagnosis and treatment of pancreatic portal hypertension

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