Risk of Varices Bleeding after Spleen-Preserving Distal Pancreatectomy with Excision of Splenic Artery and Vein

Spleen-preserving distal pancreatectomy with excision of splenic vessels (SPDP-ESV) has been widely adopted because of its simplicity. However, this simplified technique may lead to gastric varices and bleeding. For better understanding of the hemodynamic changes and risk of gastric variceal bleeding, we instituted a prospective study to perform serial follow-up contrast abdominal computed tomography (CT) and endoscopy for patients after SPDP-ESV. There were 37 patients, with a mean follow-up period of 45.3 months (range 23-59 months), included in the analysis. Of the 37 patients studied, 11 (29.7%) had perigastric varices, 12 (32.4%) had splenomegaly, and 3 (8.1%) had gastric submucosal varices on follow-up CT performed 6 months after surgery. Endoscopy also showed gastric varices in three patients with gastric submucosal varices on CT scan. CT performed 18 months after surgery showed no progression of splenomegaly or gastric submucosal varices. Follow-up endoscopies also showed three gastric varices detected on endoscopy at 6 months to be stationary. Based on serial CT and endoscopic examinations, the first postoperative months will show who is at risk of gastric variceal bleeding.