Current outcome of portal vein thrombosis in adults: Risk and benefit of anticoagulant therapy

Natural history and management of esophagogastric varices in chronic noncirrhotic, nontumoral portal vein thrombosis

“…(10) Variceal bleeding was the first manifestation of PVT in 27 patients (15%), similar to what was reported in other previous studies in patients without cirrhosis or malignancy. (3,13) It is important to note that the number of patients in whom variceal bleeding was the first manifestation of PVT markedly decreased with time. Indeed, only seven of the 120 (6%) patients diagnosed with PVT after 2001 had variceal bleeding as the presenting symptom of chronic PVT.…”

“…Follow-up endoscopy was not performed due to follow-up time <2 years in five patients and for unknown reasons in four. Median elapsed time was 27 months (range 9-218) months, the time/endoscopy index was 11 (range 5-83) months, and the median number of endoscopies performed was two (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

“…(1,2) Indeed, several retrospective cohort studies have shown a high prevalence of esophageal varices (EVs) at the time of chronic PVT diagnosis. (3,4) Due to the low incidence and prevalence of PVT, specific studies aimed at determining adequate strategies for endoscopic screening and management of varices are scarce and small-sized. Consequently, the 2015 Baveno VI Consensus suggested applying to patients with PVT the same recommendations validated for patients with cirrhosis and portal hypertension, i.e., to perform a baseline endoscopy at diagnosis of PVT and subsequent endoscopies at 2-year or 3-year intervals in patients with no EVs or small EVs (SEVs) at baseline, to use beta-blockers or endoscopic band ligation (EBL) as a primary prophylaxis, and to Abbreviations: EBL, endoscopic band ligation; EV, esophageal varix; GOV, gastroesophageal varix; GV, gastric varix; IGV, isolated gastric varix; LEV, large esophageal varix; NSBB, nonselective beta-blocker; PVT, portal vein thrombosis; SEV, small esophageal varix.…”

Portal Vein Thrombosis

“…The intra-abdominal inflammatory conditions leading to sepsis that cause PVT include pancreatitis, cholecystitis, cholangitis, appendicitis, liver abscess and local injury to portal venous axis following splenectomy including laparoscopic splenectomy, laparoscopic colectomy, abdominal trauma, portocaval shunts & other intra-abdominal surgical procedures in association with the above acquired or inherited prothrombotic conditions. [40][41][42][43][44] A recent study of 102 patients with non-cirrhotic non-malignant acute PVT showed the presence of local factors as a cause for thrombosis in upto 21% and acute pancreatitis as the most common cause followed by cholecystitis or cholangitis and liver abscess. 45 PVT may also occur after ablative therapy for HCC and fine needle aspiration of pancreatic mass.…”

“…Bowel infarction is an important cause of mortality in patients with thrombosis of portal venous system. 40 Partial obstruction of portal vein may be associated with lesser symptoms. Acute development of ascites, although rare, may also be seen which is usually mild and transient due to intestinal venous congestion.…”