Incidence, Risk Factors and Outcomes of Jejunal Varix of the Afferent Loop after Pancreatoduodenectomy

Abstract

Introduction: Jejunal varices is a worrisome late complication after PD due to recurrent and intractable bleeding. The objective of this study was to determine the incidence, risk factors, and outcomes of jejunal varices after pancreatoduodenectomy (PD). Methods: 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(³50%) and jejunal varices, which was defined as engorged dilated veins >3mm. Results: Jejunal varices developed in 83 (11.7%) patients after a median duration of 12 (5-21) months after PD. Among those patients, 18 (21.7%) 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 20 patients with PV stent placement, variceal bleeding occurred in 4 of 9 patients with stent thrombosis, but not in 11 patients without stent thrombosis. Conclusions: 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.