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16 February 2023 at 14h39 in reply to: Multicentric register about left-sided portal hypertension in pancreatic cancer #4453
Xingshun Qi
ParticipantDear Macarena Simón-Talero,
I want to discuss with you about the selection of patients. But I cannot make a reply to your email address macarena.simontalero@vallhebron.cat
Do you have an alternative email address?
Thank you.
Best,
Xingshun Qi
China
xingshunqi@126.comXingshun Qi
ParticipantPlease provide the images of pancreas to further identify the presence of pancreatic disease related portal hypertension.
There is some evidence regarding anticoagulation for splenic vein thrombosis, but controversy remains.
Additionally, as mentioned by you, there is some case series evidence regarding stent for splenic vein thrombosis.
Endoscopic treatment with cyanoacrylate should be cautious. Occlusion of gastric varices will further increase the pressure of local left portal hypertension secondary to splenic vein thrombosis. Risk of recurrence of gastric variceal bleeding is high.Xingshun Qi
ParticipantThank you for your further information.
Supporting point for long-term anticoagulation is an occlusive PVT. Spontaneous recanalization is difficult. I remember a case report by Prof. Garcia-Pagan in J Hepatol showing a complete recanalization for CTPV after long-term anticogulation.
Opposing points for long-term anticoagulation are negative thrombophilia, without mesenteric vein involvment, non-LT listed, and a low PLT. Indeed, you can find that a majority of patients included in published studies regarding anticoagulation for PVT do not have a low PLT. So your hematologist’ considerations are reasonable.
Generally, no high-level evidence has been provided, especially in INCPH. Regardless of your final decision, a close monitoring is very necessary. For anticoagulation, please monitor the bleeding risk. For non-anticoagulation, please monitor thrombus progression.
Xingshun Qi
ParticipantAn interesting case.
According to your words, this patient may be diagnosed with INCPH complicated with PVT and hypersplenism (PLT 40-50). You want to balance the benefit and risk of anticoagulation for such a patient. Some details should be further given before an effective discussion.
First, despite you said that the size of thrombosis was unchanged, could you please tell us the detailed extension and grade of PVT? The severity of PVT is an important factor for determining long-term anticoagulation or not.
Second, INCPH often has a good liver function and prognosis. Liver transplantation is not necessary in most of INCPH cases. Could you please tell us the detailed liver function.
Third, we do not have any evidence that PVT increases the mortality of INCPH. Similarly, we do not have any evidence that anticoagulation increases the survival of INCPH.
Xingshun Qi
ParticipantDear Andrea,
What is ERN?
Best,
Xingshun -
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