Atif Zaman, MD, MPH reviewing Sarin SK et al. Gastroenterology 2016 Aug 27.

Commentary authors propose a more comprehensive classification system.

Portal vein thrombosis (PVT) is a complete or partial obstruction owing to thrombus of the portal venous system; the development of a cavernoma (cavernous transformation) indicates chronic thrombosis. In the current position paper, the authors review the incidence and natural history of PVT in patients with cirrhosis and propose new classification criteria.

The cumulative incidence of PVT in patients with cirrhosis has been estimated at 5%–13%, 10%–20%, and about 39% at years 1, 5, and 8–10, respectively. The natural history of PVT in this population is highly variable. Spontaneous resolution is reported to occur in 31%–70% of cases, regression in up to 47%, stable disease in 45%, and progression in 7%. PVT is symptomatic in an estimated 38%–57% of cases, as evidenced by hepatic decompensation, abdominal pain, and even bowel ischemia.

The authors note that although the prognosis in patients with PVT is dependent more on clinical presentation and less on the anatomical location of the thrombosis, European and American guidelines predominantly emphasize the latter. They propose a new classification that includes not only PVT site and extent of occlusion, but also presentation (acute or chronic), whether disease is asymptomatic or symptomatic (development of decompensation, features of bowel ischemia, presence of portal hypertension), and the clinical setting (presence of malignancy).

CITATION(S):

Sarin SK et al. Toward a comprehensive new classification of portal vein thrombosis in patients with cirrhosis. Gastroenterology 2016 Aug 27; [e-pub].

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