MD Creighton University School of Medicine Phoenix, Arizona
Mays Almohammedawi, MBChB1, Ali Alshati, MD2, Shehroz Aslam, MD2, Simcha Weissman, DO3, Dimas Kosa, MD2, Arnold Forlemu, MD2, Toufic Kachaamy, MD4; 1Baghdad University College of Medicine, Phoenix, AZ; 2Creighton University School of Medicine, Phoenix, AZ; 3Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ; 4Cancer Treatment Centers of America, Phoenix, AZ
Introduction: Pancreatic diseases, mainly pancreatic cancer, can result in a significant portal vein (PV) and superior mesenteric vein (SMV) stenosis, which in turn leads to all the complications associated with portal hypertension. The aim of this review is to evaluate the efficacy of stenting of PV/SMV stenosis due to pancreatic diseases. Methods: In April 2020, we searched English language case series and case reports using PubMed, Scopus, Google Scholar, MEDLINE, ScienceDirect, CINAHL Complete, and Cochrane Library. Search keywords included, but not limited to pancreatic cancer/adenocarcinoma, pancreatitis, portal vein, superior mesenteric vein, stenosis, and stenting. Inclusion criteria included transileocolic (TI) or percutaneous transhepatic (PT) stenting of non-transplant PV/SMV stenosis secondary to pancreatic cancer or pancreatitis, excluding biliary and hepatic malignancies. Results: Twenty case series and case reports of 61 patients met the inclusion criteria. The studies were published between 1993 and 2019. The age of patients was between 22 and 86 years (average 63) with male predominance (60%). The main presenting symptoms included ascites and melena. The vast majority of patients had PV stenosis. Most of the cases had pancreatic cancer status post pancreatoduodenectomy (90%) as the etiology of PV/SMV stenosis. PT venoplasty was performed in 68%, while the TI approach in the remaining 32%. Portal venous pressure gradient (PVPG) was measured in 31 patients and was lowered from an average of 12.3 mmHg to 1.7 mmHg. Most of the patients had a high technical success rate and achieved symptomatic relief. Stent patency rate was widely variable 20 days to 7 years. Discussion: PV stenting is a widely accepted method to improve portal hypertension symptoms in the setting of liver transplantation. In non-transplant patients, TI and PT stenting of PV/SMV stenosis have only been reported in case reports/case series with a small number of patients. Thus, their efficacy remains unclear. In this abstract, we specifically reviewed the utility of stenting of PV/SMV stenosis in the setting of pancreatic pathology. Results demonstrated relief of portal hypertension-related symptoms and improvement of the quality of life. The drop in PVPG can be used as a measurable tool to demonstrate improved outcomes. Per our literature review, this is the first report reviewing the stenting of PV/SMV stenosis due to pancreatic disease. Further studies are needed to determine the efficacy and safety of these procedures.
Table 1: Summary of the studies included in the review
Disclosures: Mays Almohammedawi indicated no relevant financial relationships. Ali Alshati indicated no relevant financial relationships. Shehroz Aslam indicated no relevant financial relationships. Simcha Weissman indicated no relevant financial relationships. Dimas Kosa indicated no relevant financial relationships. Arnold Forlemu indicated no relevant financial relationships. Toufic Kachaamy indicated no relevant financial relationships.