CT Findings of Afferent Loop Varices After Bilioenteric Anastomosis in Patients With Malignant Disease

Abstract

The purpose of this study was to determine the prevalence and CT findings of afferent jejunal loop varices after bilioenteric anastomosis in patients with malignancy. The study included 99 patients who underwent bilioenteric anastomosis for malignancy and follow-up CT examinations. Two abdominal radiologists reviewed CT images for the presence of afferent loop varices. They also assessed for the presence of extrahepatic portal occlusion or stenosis, other collateral vessels, ascites, splenomegaly, and recurrent tumor. Clinical data regarding age, sex, and histories of pancreaticoduodenectomy and surgery on the portal vein, radiation therapy, and postoperative gastrointestinal bleeding were collected. Univariate and multivariate analyses were performed to discern significant factors associated with afferent loop varices. Cumulative incidence was estimated with the Kaplan-Meier method. Afferent loop varices were found in 22 of the 99 patients (22.2%), and the 48-month cumulative incidence of afferent loop varices was 28.0%. Three of the 22 patients (13.6%) eventually experienced gastrointestinal bleeding. Obstruction in the extrahepatic portal system was the only feature that exhibited a significant difference in multivariate analysis (relative risk, 71.4; 95% CI, 7.4-1000). Afferent loop varices detected after bilioenteric anastomosis on CT images had a prevalence of 22.2% and can result in gastrointestinal bleeding. The presence of obstruction in the extrahepatic portal system was significantly associated with afferent loop varices.