title: Extrahepatic portal venous system thrombosis in recurrent acute and chronic alcoholic pancreatitis is caused by local inflammation and not thrombophilia.
abstract: OBJECTIVE
  Extrahepatic portal venous system thrombosis (EPVST) occurs in 13% of patients with either recurrent acute (AP) or chronic (CP) alcoholic pancreatitis. The role of thrombophilia has never been assessed in this entity.
  
  
  METHODS
  All consecutive patients with alcoholic AP or CP were included in a prospective study. All patients underwent a computerized tomography (CT) scan of the pancreas to evaluate EPVST as well as thorough testing for thrombophilia (protein C, S, and antithrombin deficiency, factor II, factor V, and JAK2 gene mutations, homocystein, biological antiphospholipid syndrome).
  
  
  RESULTS
  A total of 119 patients (male, n=100 (84%); smokers, n=110 (92%)) were included. EPVST was found in 41 patients (35%). The portal, superior mesenteric, or splenic veins were involved in 34%, 24%, and 93% of patients, respectively. Thrombophilia was identified in 18% (n=22), including the biological antiphospholipid syndrome, factor V Leiden mutation, and factor II G20210A gene mutation in 21 (17.6%), 2 (1.6%), and 1 patient (0.8%), respectively. On univariate analysis, the factors associated with EPVST were smoking (RR=1.6 (1.38-1.85), P=0.03), pseudocysts (RR=2.91 (1.29-6.56), P=0.008), a pseudocyst in the pancreatic tail (P=0.03), a high CT severity index for AP (P=0.007), and pancreatic parenchymal necrosis (P=0.02). The presence of hemostatic risk factors was not associated with an increased risk of EPVST. On multivariate analysis, only pseudocysts were associated with EPVST (hazard ratio: 6.402; 95% confidence interval (1.59-26.54), P=0.009).
  
  
  CONCLUSIONS
  EPVST is found in 35% of patients with acute/chronic alcoholic pancreatitis. Local inflammation appears to be the major predisposing condition. The presence of some form of thrombophilia does not increase the risk of EPVST and should not be systematically searched for in case of EPVST.
authors: Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hôpital Beaujon, AP-HP, Clichy, Inserm U773-CRB3, Université Paris-Diderot, Clichy, France. vinciane.rebours@bjn.aphp.fr
authors: Vinciane
authors: V
authors: Rebours
authors: Larbi
authors: L
authors: Boudaoud
authors: Marie-Pierre
authors: MP
authors: Vullierme
authors: Dominique
authors: D
authors: Vidaud
authors: Bertrand
authors: B
authors: Condat
authors: Olivia
authors: O
authors: Hentic
authors: Frédérique
authors: F
authors: Maire
authors: Pascal
authors: P
authors: Hammel
authors: Philippe
authors: P
authors: Ruszniewski
authors: Philippe
authors: P
authors: Lévy
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications*; D000704:Analysis of Variance; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010195:Pancreatitis / Q000209:etiology* / Q000473:pathology; D011169:Portal Vein; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000209:etiology*