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Hildenbrand FF, Wohlwend C, von Felten S, Rodewald AK, Murray FR, The FO, Bütikofer S, Gubler C, Morell B. Clinical parameters associated with gastric portal hypertensive polyps. Scand J Gastroenterol 2022; 57:984-989. [PMID: 35306948 DOI: 10.1080/00365521.2022.2045352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Portal hypertensive polyps (PHPs) are incompletely characterized lesions that can be found in the distal stomach of patients with portal hypertension. We aimed to delineate clinical factors associated with the appearance of these rare polyps. MATERIAL AND METHODS We conducted a cross-sectional study of a cohort with 513 cirrhotic patients comparing patients with and without PHP using descriptive analyses and multivariable logistic regression. To address the problem of missing values, in particular for HVPG and liver stiffness, we used multiple imputation of missing values. RESULTS The prevalence of macroscopically diagnosed PHP was 3.3% (95% confidence interval 2.0 - 5.4%). In 53% of cases, the correct classification was missed on index gastroscopy. Patients with PHP were older at gastroscopy (65 years vs. 59), had higher hepatic venous pressure gradients (HVPG, 28 mmHg vs. 19 mmHg), higher transient elastography (TE) measurements (50.7 kPa vs. 21.8 kPa) and more often had previous rubber band ligations (RBL, 64.7% vs. 25.8%). The multivariable logistic regression on the outcome macroscopically diagnosed PHP estimated an odds ratio (OR) for HPVG of 1.13 (CI 0.95-1.34), increased liver stiffness of 1.03 (1.00 - 1.07) and previous RBL of 3.84 (1.24 - 11.88), respectively. CONCLUSION The prevalence of PHPs in the stomach was higher than assumed in previous studies and misclassification was commonly observed. The appearance of these rare polyps is associated with previous RBL and may correlate with severity of PH. Thus, PHPs may be regarded as marker for relevant PH, but clinical significance of these polyps is still uncertain.
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Affiliation(s)
| | - Chantal Wohlwend
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Stefanie von Felten
- Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zürich, Zürich, Switzerland
| | - Ann-Katrin Rodewald
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland
| | - Fritz Ruprecht Murray
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Division of Gastroenterology and Hepatology, Stadtspital Zürich, Zürich, Switzerland
| | - Frans Olivier The
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Division of Gastroenterology and Hepatology, Stadtspital Zürich, Zürich, Switzerland
| | - Simon Bütikofer
- Gastroenterology and Hepatology Unit, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Christoph Gubler
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Division of Gastroenterology and Hepatology, Stadtspital Zürich, Zürich, Switzerland
| | - Bernhard Morell
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Division of Gastroenterology and Hepatology, Stadtspital Zürich, Zürich, Switzerland
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Héroin L, Saviano A, Fenouil T, Sosa-Valencia L, Baumert TF, Habersetzer F, Mayer P. Differences between sporadic hyperplastic gastric polyps and portal hypertensive gastric polyps: a review. Eur J Gastroenterol Hepatol 2022; 34:260-266. [PMID: 34432677 DOI: 10.1097/meg.0000000000002278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Portal hypertension (PH) is one of the most severe complications of chronic liver diseases. It is defined as an increase in pressure in the portal venous system which results in a portosystemic gradient >5 mmHg. In the western world, cirrhosis is the most frequent cause of PH, mainly due to nonalcoholic fatty liver disease and alcoholic liver disease. Patients with PH have esophageal varices in 68-73% of cases, portal hypertensive gastropathy in 51-73% and hyperplastic polyps (HPs) in 0.9-2%. Recent studies have shown that HPs found in PH patients are different from classical HPs. They constitute a new entity called portal hypertensive polyps (PHPs). The main difference between sporadic HPs and PHP is the presence of larger and more numerous vascular capillaries in the lamina propria. The clinical course of PHPs is unknown. Their physiopathology seems different from HPs: the increased congestion caused by higher portal pressure in the stomach may induce capillaries proliferation and neoangiogenesis. PHPs may be responsible for symptoms, such as pyloric obstruction, iron deficiency and anemia. Their prevalence in portal hypertensive and cirrhotic patients is from 1% to 8%. PHPs can be single or numerous, in the antrum or the gastric corpus. Their size ranges from 2 to 3 cm. PHPs seem to disappear or shrink with the treatment of PH. They should be resected in case of symptom and if >10 mm, after Helicobacter pylori eradication if present. However, their recurrence is frequent (40-79%), thus surveillance endoscopy is mandatory, at the same time as esophageal varices.
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Affiliation(s)
- Lucile Héroin
- Gastroenterology and Hepatology Unit, Hôpitaux Universitaires de Strasbourg
| | - Antonio Saviano
- Gastroenterology and Hepatology Unit, Hôpitaux Universitaires de Strasbourg
- Université de Strasbourg
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg
| | - Tanguy Fenouil
- Institute of Pathology Est, Hospices Civils de Lyon, Lyon
| | | | - Thomas F Baumert
- Gastroenterology and Hepatology Unit, Hôpitaux Universitaires de Strasbourg
- Université de Strasbourg
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg
| | - François Habersetzer
- Gastroenterology and Hepatology Unit, Hôpitaux Universitaires de Strasbourg
- Université de Strasbourg
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg
| | - Pierre Mayer
- Gastroenterology and Hepatology Unit, Hôpitaux Universitaires de Strasbourg
- Université de Strasbourg
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3
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Polese L, La Raja C, Fasolato S, Frigo AC, Angeli P, Merigliano S. Endoscopic diode laser therapy for gastric hyperplastic polyps in cirrhotic patients. Lasers Med Sci 2020; 36:975-979. [PMID: 32815064 DOI: 10.1007/s10103-020-03127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
Purpose Endoscopic polypectomy to remove gastric hyperplastic polyps in cirrhotic patients is associated to a high risk of postprocedural bleeding. The current study set out to examine the effect of diode laser therapy used to treat this type of polyps in cirrhotic patients. Methods This single-center study retrospectively examined the data of cirrhotic patients with macroscopic bleeding or anemia who underwent diode laser therapy (940 nm wave length, 30-W power setting in continuous mode) to remove histology-confirmed hyperplastic gastric polyps. Results A total of 222 polyps (mean diameter 10 ± 8 mm) were treated in 55 patients who were included in the study. No complications such as bleeding or perforations were reported. After a mean of 5 ± 4 sessions, 31 patients (56%) were completely healed. In 16 patients (29%), there was only a partial response (mean polyp reduction diameter of 64 ± 15%), while 8 (15%) patients did not respond to treatment. Statistically significant better results were noted in the patients who underwent ≥ 2 laser sessions. Hemoglobin levels and number of blood transfusions required were not statistically different after treatment. After a mean study period of 21 ± 17 months, polyp recurrences were noted in 11 patients (20%), but none of the polyps had degenerated. Conclusion Diode laser therapy was found to be a safe treatment for hyperplastic polyps in cirrhotic patients. Due to the presence of others bleeding lesions in cirrhotic patients, this treatment did not have an impact on anemia and transfusion requirements.
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Affiliation(s)
- Lino Polese
- Department of Surgery, Oncology and Gastroenterology, Third Surgical Unit, University of Padova, Padua, Italy. .,Clinica Chirurgica 3, Policlinico Universitario 6 Piano, Via Giustiniani 2, 35128, Padova, Italy.
| | - Carlotta La Raja
- Department of Surgery, Oncology and Gastroenterology, Third Surgical Unit, University of Padova, Padua, Italy
| | - Silvano Fasolato
- Department of Medicine, 5th Medical Unit, University of Padova, Padua, Italy
| | - Anna Chiara Frigo
- Department of Cardiology, Chest and Vascular Surgery, University of Padova, Padua, Italy
| | - Paolo Angeli
- Department of Medicine, 5th Medical Unit, University of Padova, Padua, Italy
| | - Stefano Merigliano
- Department of Surgery, Oncology and Gastroenterology, Third Surgical Unit, University of Padova, Padua, Italy
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Seleem WM, Hanafy AS. Management of a Portal Hypertensive Polyp: Case Report of a Rare Entity. Gastrointest Tumors 2019; 6:137-141. [PMID: 31768357 DOI: 10.1159/000501909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/04/2019] [Indexed: 12/29/2022] Open
Abstract
Portal hypertensive polyposis is a rare finding represented in about 2.5% of all patients with portal hypertension. The diagnostic criteria are not yet clearly defined. It has been mentioned in a few case reports; its distribution was mainly duodenal and less frequently gastric. Here, a patient with type 2 diabetes and liver cirrhosis was hospitalized for vomiting, abdominal pain, and melena. The patient was admitted to the intensive care unit for stabilization and urgent esophagogastroduodenoscopy (EGD). EGD revealed a single antral polyp occluding the pyloric ring which was the cause of gastric outlet obstruction. Complete debulking by argon plasma was done which improved gastric outlet obstruction and melena. We conclude that argon plasma coagulation is a safe, rapid, and effective method for treating portal hypertensive polyposis.
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Affiliation(s)
- Waseem M Seleem
- Hepatogastroenterology Division - Internal Medicine, Gastroenterology and Hepatology, Zagazig University, Zagazig, Egypt
| | - Amr Shaaban Hanafy
- Hepatogastroenterology Division - Internal Medicine, Gastroenterology and Hepatology, Zagazig University, Zagazig, Egypt
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Portal Hypertensive Polyposis in Advanced Liver Cirrhosis: The Unknown Entity? Can J Gastroenterol Hepatol 2018; 2018:2182784. [PMID: 30155451 PMCID: PMC6093009 DOI: 10.1155/2018/2182784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/15/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Portal hypertension is a serious complication of liver cirrhosis. OBJECTIVE To identify relevant endoscopic findings in patients with advanced cirrhosis and consecutive portal hypertension. METHODS This was a retrospective study of liver transplant candidates who underwent upper gastrointestinal endoscopy between April 2011 and November 2015. RESULTS A total of 1,045 upper endoscopies were analyzed. Portal hypertensive gastric and duodenal polyps were frequently observed and were associated with thrombocytopenia (p = 0.040; OR: 2.4, 95% CI 1.04-5.50), Child-Pugh score > 6 (p = 0.033; OR: 2.3, 95% CI 1.07-4.92), Model for End Stage Liver Disease score > 16 (p = 0.030; OR: 4.1, 95% CI 1.14-15.00), and previous rubber band ligation (p < 0.001; OR = 5.2, 95% CI 2.5-10.7). These polyps often recurred after polypectomy; however, no malignant transformation occurred during the observational time until October 2017. The most common endoscopic finding was esophageal varices, observed in more than 90% of patients. CONCLUSION Portal hypertensive polyposis is common in patients with advanced cirrhosis. Our data suggest that these polyps have benign characteristics.
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Sigounas DE, Shams A, Hayes PC, Plevris JN. Endoscopic ultrasound assessment of gastrointestinal polypoid lesions of indeterminate morphology in patients with portal hypertension. Endosc Int Open 2018; 6:E292-E299. [PMID: 29507869 PMCID: PMC5832462 DOI: 10.1055/s-0043-124363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 10/25/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Polypoid lesions found during upper gastrointestinal endoscopy (UGIE) are occasionally found in patients with portal hypertension (PH). This study aimed to assess the true nature of such polypoid lesions using endoscopic ultrasound (EUS) and determine the accuracy of UGIE in differentiating between vascular and non-vascular lesions in PH. PATIENTS AND METHODS We retrospectively assessed all patients with PH referred for EUS due to polypoid lesions of unknown nature at UGIE over a 7-year period. Cases of known varices were excluded. UGIE findings were compared to EUS findings. RESULTS 66 patients were included (26 male). Commonest UGIE findings were: possible varices (19.4 %), polypoid/neoplastic lesion (52.8 %) and submucosal lesion (16.7 %). After EUS, the final diagnoses were: varices in 25 %, polypoid lesion with underlying vessel/varix in 27.8 % and non-vascular lesion or submucosal lesion in 47.2 %. The diagnostic accuracy of UGIE was suboptimal, since 28.6 % of possible varices were eventually found to be non-vascular, while 15.8 % of polyp/neoplastic looking lesions proved to be varices and 42.1 % were lesions with underlying vessel/varix. 50 % of submucosal lesions were eventually found to be varices. CONCLUSION Endoscopists should have a high index of suspicion of varices or polyps related to varices when assessing atypical looking polypoid lesions in patients with PH. In such cases EUS should be considered before obtaining biopsies.
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Affiliation(s)
- Dimitrios E. Sigounas
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Amanullah Shams
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Peter C. Hayes
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - John N. Plevris
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom,Corresponding author Professor John Plevris PI, Hepatology LaboratoryAssociated PI CIRUniversity of EdinburghFirst Floor Chancellor’s Building49 Little France CrescentEdinburgh EH16 4SA
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Pai CG. Portal hypertensive polyp--what is in a name? Indian J Gastroenterol 2013; 32:163-4. [PMID: 23475552 DOI: 10.1007/s12664-013-0331-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 02/16/2013] [Indexed: 02/04/2023]
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