P0484 - Variceal Bleeding in Pancreatic Cancer - Should We Worry?

Syed Alishan Nasir, MD, Wesley Calvin, , Naveen Anand, MD
Norwalk Hospital, Norwalk, CT

Introduction: Portal hypertension (PTH) is defined as a hepato-venous pressure gradient > 5 mmHg and is most associated with liver cirrhosis. PTH can also develop in the absence of liver cirrhosis, and this is termed as non-cirrhotic portal hypertension. Pancreatic cancer (PC) happens to be one such cause of non-cirrhotic PTH. The most common complication from PC-PTH happens to be ascites which can be seen in up to 5% of patients with PC however serious complications such as esophageal varices (EV) are rare. Herein we present a rare case of variceal bleed resulting from PTH in a patient with aggressive pancreatic cancer.

Case Description/Methods: A 74-year-old female with a history of coronary artery disease presented with complaints of intermittent, diffuse, post prandial abdominal pain of 2 months duration with an associated 15-pound weight loss. On initial evaluation, she was found to have a hemoglobin of 7.6 g/dL (baseline 10-11 g/dL). CT scan of the abdomen & pelvis showed an ill-defined, hypodense, 6 x 4 x 4 cm lesion within the pancreatic head and uncinate process, encasing the common hepatic artery, gastroduodenal arteries and the confluence of the superior mesenteric vein, splenic vein and portal vein. No hepatic lesions were present but perihepatic ascites and splenomegaly were noted. Gastroenterology was consulted and plans were made to pursue EUS/ERCP which showed 5 columns of large, > 5mm, grade III esophageal varices with stigmata of recent bleeding (red wale signs) in the mid esophagus and distal esophagus.7 bands were successfully placed with eradication of esophageal varices. The patient was subsequently admitted to the hospital and started on an octreotide drip, broad-spectrum antibiotics for SBP prophylaxis and a therapeutic paracentesis was planned. Ascites fluid analysis showed a SAAG greater than 1.1. Biopsy samples from EUS and cytology from ascites fluid resulted in the diagnosis of pancreatic adenocarcinoma and the patient was referred to oncology for neoadjuvant chemotherapy.

Discussion: While PTH has been reported in patients with PC, gastrointestinal bleeding remains a rare complication. A 2018 study assessed bleeding risk factors in patients with PC associated PTH and found that splenomegaly was an independent risk factor for variceal hemorrhage. Currently, there are no guidelines for EV surveillance in patients with PC. We present this case to highlight EV as an important complication of PC, one that may not be considered in patients who do not have pre-existing liver disease.



Disclosures:


Syed Alishan Nasir, MD, Wesley Calvin, , Naveen Anand, MD. P0484 - Variceal Bleeding in Pancreatic Cancer - Should We Worry?, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.