O127: Global DELPHI Consensus Study on anticoagulation for splanchnic vein thrombosis in acute pancreatitis

Abstract

Abstract Introduction Splanchnic vein thrombosis (SpVT) occurs in 16.6%-22.6% of acute pancreatitis cases, influenced by pancreatitis severity and imaging techniques. Serious sequelae include hepatic and bowel failure, while management with anticoagulation remains controversial amidst perceived bleeding risks. This study's aim, driven by heterogeneity in literature, utilized DELPHI methodology to discern expert consensus on SpVT treatment, advocating for standardized research approaches. Methods Using purposive, non-probability sampling and DELPHI methodology, n=173 global experts in SpVT-related acute pancreatitis were engaged from international networks. From April 2022-2023, a three-round Delphi process was implemented to completion. n=26 statements were posed, spanning diagnosis, prognosis, management, and outcomes, with feedback via a 4-point Likert scale. By Round 3, n=54/173 participants remained. Results The mean acute pancreatitis caseload per expert per year was 68.0, 72.6 and 73.0 across successive DELPHI rounds. Regarding SpVT anatomical location, there was strong consensus favouring anticoagulation for portal vein (90.7%) and SMV thrombosis (92.6%), but no consensus to treat splenic vein thrombosis (48.2%). 83.7% advocated anticoagulation for complete thrombus occlusion and 70.9% for partial occlusion. Expert views on anticoagulation duration were dichotomous, with 40.7% endorsing 3 or 6 months. In DELPHI Round 3, 74.1% rejected radiological resolution as a definitive treatment endpoint. Conclusion Grading of recommendations for SpVT treatment is precluded by heterogeneity in the evidence base. This inaugural DELPHI study underscores the salient considerations for future research. Overwhelming consensus stratified treatment for SpVT localization and degree of thrombus occlusion. 94.5% of experts agree on the feasibility of RCT to investigate treatment of SpVT.