Scott Michael, Ghazanfar Mudassar, Windsor John, Ramsay George, Bekheit Mohamed
General Surgery ST1 Trainee, Paediatric Surgery, Royal Hospital for Children and Young People, Edinburgh, EH16 4TJ, UK.
General and HPB Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK.
HPB (Oxford). 2025 Mar;27(3):343-351. doi: 10.1016/j.hpb.2024.12.002. Epub 2024 Dec 11.
Splanchnic vein thrombosis (SpVT) occurs in 17%-23 % of acute pancreatitis cases. Serious sequelae include hepatic and bowel ischaemia. However, management with therapeutic anticoagulation remains controversial due to potential bleeding risk. We aim to determine the level of consensus on prognosis, diagnosis, management, and outcomes of SpVT through a DELPHI process.
Using purposive, non-probability sampling and DELPHI methodology, 173 clinicians with experience of SpVT in acute pancreatitis were approached. From April 2022 to April 2023, a three-round DELPHI process was implemented to completion. A total of 88 statements were posed for ranking via a four-point Likert scale.
The mean acute pancreatitis caseload per respondent per year was 68·0, 72·6 and 73·0 for DELPHI rounds 1,2 and 3 respectively. For SpVT anatomical location, there was strong consensus favouring anticoagulation for portal vein (89·1 %) and SMV thrombosis (90·9 %), and no consensus to treat splenic vein thrombosis (47·3 %). 74·1 % rejected radiological resolution as a definitive anticoagulation endpoint. Majority consensus favoured death, bleeding risk, bowel or liver ischaemia, hospital admission length and ITU admission as significant outcomes for experimental research design.
There was significant consensus for anticoagulation treatment of SpVT of the portal and superior mesenteric veins, especially with complete occlusion by thrombosis. Randomised controlled trials are required to grade management recommendations.
内脏静脉血栓形成（SpVT）发生于17%-23%的急性胰腺炎病例中。严重的后遗症包括肝脏和肠道缺血。然而，由于潜在的出血风险，治疗性抗凝管理仍存在争议。我们旨在通过德尔菲法确定关于SpVT的预后、诊断、管理和结局的共识水平。
采用目的抽样、非概率抽样和德尔菲法，联系了173名有急性胰腺炎SpVT治疗经验的临床医生。从2022年4月到2023年4月，实施了三轮德尔菲法并完成。总共提出了88条陈述，通过四点李克特量表进行排序。
德尔菲法第1轮、第2轮和第3轮中，每位受访者每年的急性胰腺炎病例平均数量分别为68.0、72.6和73.0。对于SpVT的解剖位置，对于门静脉（89.1%）和肠系膜上静脉血栓形成（90.9%），强烈支持抗凝，而对于脾静脉血栓形成，没有治疗共识（47.3%）。74.1%的人拒绝将影像学缓解作为确定的抗凝终点。大多数人一致认为，死亡、出血风险、肠道或肝脏缺血、住院时间和入住重症监护病房是实验研究设计的重要结局。
对于门静脉和肠系膜上静脉的SpVT，尤其是血栓完全阻塞的情况，抗凝治疗存在显著共识。需要进行随机对照试验来分级管理建议。
