ACG issues new guideline on hepatic, mesenteric circulation disorders

The American College of Gastroenterology released a new guideline on disorders of the mesenteric, portal, and hepatic veins and mesenteric and hepatic arteries, which can lead to acute liver failure, chronic liver disease, noncirrhotic portal hypertension, cirrhosis, and hepatocellular carcinoma.

In addition to the risks for incidence liver disease, “these disorders play an important role as precipitating factors for the development and progression of complications in patients with existing chronic liver disease,” David A. Simonetto, MD, from the Mayo Clinic in Rochester, Minnesota, and colleagues wrote.

The authors noted that while the literature in the field of vascular liver disorders is scant, these disorders are common in clinical practice.

For cases of cirrhosis, current evidence shows that hemostatic pathways are largely intact but in a precarious balance that can shift in the presence of sepsis, hypothermia, or kidney dysfunction toward inappropriate clotting or bleeding, especially in decompensated cirrhosis. The guideline recommends that whole blood viscoelastic tests may be useful to avoid unnecessary use of blood products before invasive procedures in patients with cirrhosis and prolonged international normalized ratio, although additional studies are needed to establish specific parameters.

Additionally, investigation for thrombophilia should be performed for portal and mesenteric vein thrombosis among patients with cirrhosis in the absence of obvious etiology.

“The prevalence of [portal vein thrombosis (PVT)] in patients with cirrhosis has been reported widely from about 1% in compensated cirrhosis to up to 20% among patients listed for liver transplantation,” Simonetto and colleagues wrote. “The prevalence also varies based on the imaging modality used for diagnosing PVT and the length of follow-up.”

The guideline recommends that doppler ultrasound examination should be obtained in patients with newly diagnosed cirrhosis, onset of portal hypertension, or hepatic decompensation, and that endoscopic evaluation should be performed in patients with chronic PVT to assess for esophageal and gastric varices.

The guideline also provides screening and management recommendations for portal and mesenteric vein thrombosis in patients with and without cirrhosis, Budd-Chiari syndrome, mesenteric artery aneurysms, and hereditary hemorrhagic telangiectasia.

“Vascular liver disorders are common in clinical practice, and general practitioners, gastroenterologists, and hepatologists may benefit from expert guidance in managing these patients,” the researchers wrote. – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.