title: Gastric bleeding risk following spleen preserving distal pancreatectomy with excision of the splenic vessels: a long-term follow-up.
abstract: Spleen-preserving distal pancreatectomy with resection of the splenic vessels (VR-SPDP) is an effective procedure. However, hemodynamic changes in splenogastric circulation may lead to the development of gastric varices (GV) with a risk of gastrointestinal (GI) bleeding. This retrospective study aimed to assess the long-term postoperative clinical follow-up of patients and review the late postoperative abdominal computed tomography (CT) or endoscopic examination.
  
  
  
  From 1988 to 2015, 48 consecutive VR-SPDP for benign or low-grade malignant disease were included. Late postoperative follow-up was undertaken with the use of a prospective database and assessment undertaken by CT and/or endoscopy.
  
  
  
  The median follow-up was 76 months (range: 12-334 months). Two patients were lost to follow-up. Gastrointestinal hemorrhage occurred in one patient. Endoscopy and abdominal CT showed submucosal GV in five patients. Ten patients had perigastric varices (27%), but none developed clinical complications from their varices. All varices occurred within one year after distal pancreatectomy and remained stable during follow-up.
  
  
  
  Asymptomatic varices frequently occurred in patients who underwent VR-SPDP, but bleeding risk seemed low. Abdominal CT could identify GV and distinguish submucosal varices with a higher risk of gastric bleeding.
authors.affiliation: Department of General and Digestive Surgery - Purpan University Hospital - CHU de Toulouse, Place du Dr Baylac, 31059 Toulouse, France.
authors.forename: D
authors.initials: D
authors.lastname: Louis
authors.affiliation: Department of General and Digestive Surgery - Purpan University Hospital - CHU de Toulouse, Place du Dr Baylac, 31059 Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Alassiri
authors.affiliation: Department of General and Digestive Surgery - Purpan University Hospital - CHU de Toulouse, Place du Dr Baylac, 31059 Toulouse, France.
authors.forename: S
authors.initials: S
authors.lastname: Kirzin
authors.affiliation: Department of General and Digestive Surgery - Purpan University Hospital - CHU de Toulouse, Place du Dr Baylac, 31059 Toulouse, France.
authors.forename: S
authors.initials: S
authors.lastname: Blaye-Felice
authors.affiliation: Department of General and Digestive Surgery - Purpan University Hospital - CHU de Toulouse, Place du Dr Baylac, 31059 Toulouse, France.
authors.forename: M
authors.initials: M
authors.lastname: Chalret du Rieu
authors.affiliation: Department of General and Digestive Surgery - Purpan University Hospital - CHU de Toulouse, Place du Dr Baylac, 31059 Toulouse, France.
authors.forename: C H
authors.initials: CH
authors.lastname: Julio
authors.affiliation: Department of General and Digestive Surgery - Purpan University Hospital - CHU de Toulouse, Place du Dr Baylac, 31059 Toulouse, France.
authors.forename: E
authors.initials: E
authors.lastname: Bloom
authors.affiliation: Department of General and Digestive Surgery - Purpan University Hospital - CHU de Toulouse, Place du Dr Baylac, 31059 Toulouse, France.
authors.forename: L
authors.initials: L
authors.lastname: Ghouti
authors.affiliation: Department of General and Digestive Surgery - Purpan University Hospital - CHU de Toulouse, Place du Dr Baylac, 31059 Toulouse, France.
authors.forename: B
authors.initials: B
authors.lastname: Pradère
authors.affiliation: Department of General and Digestive Surgery - Purpan University Hospital - CHU de Toulouse, Place du Dr Baylac, 31059 Toulouse, France.
authors.forename: G
authors.initials: G
authors.lastname: Portier
authors.affiliation: Department of General and Digestive Surgery - Purpan University Hospital - CHU de Toulouse, Place du Dr Baylac, 31059 Toulouse, France; INSERM UMR 1037, Cancer Research Center of Toulouse CRCT, University of Toulouse, 2 avenue Hubert Curien, 31037 Toulouse, France. Electronic address: carrere.n@chu-toulouse.fr.
authors.forename: N
authors.initials: N
authors.lastname: Carrère
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000009:adverse effects*; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013157:Splenic Artery / Q000601:surgery*; D013162:Splenic Vein / Q000601:surgery*; D013272:Stomach Diseases / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult