Incidence, risk factors, and outcomes of jejunal varices of the afferent loop after pancreatoduodenectomy

Abstract

Jejunal varices is a worrisome late complication after pancreaticoduodenectomy (PD) due to recurrent and intractable bleeding. This study was aimed to determine the incidence, risk factors, and outcomes of jejunal varices after PD. A total of 709 patients who underwent PD from 2007 to 2017 were enrolled in the study. Preoperative and postoperative follow-up CT images were reviewed to evaluate the development of portal vein (PV) stenosis (> 50%) and jejunal varices, which was defined as engorged dilated veins > 3 mm. Jejunal varices developed in 83 (11.7%) patients after a median duration of 12 (5-21) months after PD. Among those patients, 18 (21.6%) experienced variceal bleeding. PV stenosis (p < 0.001; OR 33.234, 95% CI 15.568-66.666) and PV/SMV resection (p = 0.028; OR 2.261, 95% CI 1.090-4.687) were identified as independent predicting factors for jejunal varices. None of 9 patients who underwent stent placement for PV stenosis before the formation of jejunal varices experienced variceal bleeding, whereas 18 (27.3%) of 135 patients who did not receive PV stent placement experienced at least one episode of variceal bleeding. Among 17 patients with PV stent placement, variceal bleeding occurred in 3 of 7 patients with stent thrombosis, but not in 10 patients without stent thrombosis. The results revealed that the incidence of jejunal varices was not low after PD and PV stenosis was a strong risk factor for jejunal varices. Early placement of PV stent and maintenance of stent patency could reduce the risk of variceal bleeding in patients with PV stenosis.