Advances in Management of Pancreatitis Related Portal Hypertension

Abstract

Extrahepatic portal hypertension (EPH) is hypertension that occurs in the extrahepatic portal vasculature in the absence of liver cirrhosis. Portal hypertension (PHTN) is defined as a pressure gradient between the portal vein and hepatic vein/inferior vena cava (IVC) exceeding more than 5 mm Hg. PHTN is more commonly known as a manifestation of cirrhosis and the related elevation in hepatic to venous pressure gradient (HVPG); however, there are other extrahepatic etiologies to PHTN that are important for review. Per our literary review, EPH as a complication of pancreatitis has been known as a manifestation since at least the 1970s. Among the severities of pancreatitis, it occurs most commonly with acute necrotizing pancreatitis and chronic pancreatitis. In this review, we plan to provide an understanding of mechanisms by which EPH occurs, discuss the treatments (e.g., anticoagulation, splenic artery embolization, and splenectomy) for the complications that result from prolonged EPH, and discuss the current endoscopic interventions available to counteract these complications.

Splenectomy versus non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis

“…Therapeutic strategies for bleeding from LSPH include endoscopic interventions, partial splenic arterial embolization (PSAE), and splenectomy. 10 – 13 Endoscopic interventions are widely used for gastroesophageal varices in patients with liver cirrhosis but have a high failure rate in the management of GI bleeding caused by LSPH. 12 PSAE is a major therapeutic strategy for hypersplenism.…”

“… 10 – 13 Endoscopic interventions are widely used for gastroesophageal varices in patients with liver cirrhosis but have a high failure rate in the management of GI bleeding caused by LSPH. 12 PSAE is a major therapeutic strategy for hypersplenism. Some studies demonstrated that PSAE was an effective approach for GI bleeding caused by LSPH.…”

“…Some studies demonstrated that PSAE was an effective approach for GI bleeding caused by LSPH. 12 , 14 , 15 However, the efficacy of PSAE needs to be investigated. Splenectomy is used for GI bleeding caused by LSPH by removing the spleen.…”