1248 DELPHI Consensus Study - Splanchnic Venous Thrombosis in Acute Pancreatitis

Aim

A DELPHI consensus process was conducted to identify new areas for research in the largely understudied territory of Splanchnic Venous Thrombosis (SpVT). The overarching purpose was to help establish at-risk patient subgroups, current expert therapeutic practices and key outcome measures of SpVT in the short-, medium- and long-term care of patients.

Method

Duration: 2021-2022. International pancreatitis experts designed Redcap software surveys following DELPHI consensus methodology. Stakeholder distribution was via international networks, extending outreach to SpVT experts from intensive care, pancreatology, and general/HPB surgical backgrounds, who work in tertiary centres worldwide. Question design targeted at-risk subgroups, optimal diagnostic and management modalities, and order-ranked outcomes. Blinded data analyses were performed using Redcap software.

Results

ROUND 1 n(respondents) = 73/153. ROUND 2 n(respondents) = 53/73.

75% of experts agree that SpVT increases mortality among patients with acute pancreatitis. By Round 2, there was overwhelming consensus that therapeutic anticoagulation was beneficial for Portal Vein SpVT (90.4%) and Superior Mesenteric Vein (92.3%) thromboses (SpVTs), provided there were no significant patient bleeding risk factors. No consensus was reached regarding duration of anticoagulation.

Conclusions

There exists significant heterogeneity for optimal duration of therapeutic anticoagulation to treat SpVT in acute pancreatitis. While consensus clearly suggests a role for therapeutic anticoagulation, this must achieve equipoise against risks. Our DELPHI process identified upper GI bleeding, liver ischaemia and bowel ischaemia as important outcomes of anticoagulation-based SpVT management for the short, mid- and long-terms of patient follow-up. Future DELPHI rounds will involve further enquiry into the optimal duration of anticoagulation for SpVT.