Duodenal polyposis secondary to portal hypertensive duodenopathy

Duodenal polyposis, a rare manifestation of gastrointestinal portal hypertension

Portal hypertension can affect the entire gastrointestinal tract, including the duodenum. Portal hypertensive duodenopathy may occur relatively rare in patients with portal hypertension secondary to cirrhosis or extrahepatic portal venous obstruction. We report the case of a 63-years-old female patient with cirrhosis who underwent an esophagogastroduodenoscopy. Multiple small duodenal polyps (2-3 mm) were found. The histopathologic examination of the duodenal biopsy specimen revealed a polypoid duodenal mucosa, with preserved villous architecture, with focal gastric foveolar metaplasia and numerous ectatic capillaries in lamina propria. The polypoid lesions found in the duodenum are a consequence of portal hypertension. The presence of one or several polyps in the duodenum of a patient with portal hypertension, with specific histological findings (dilated mucosal capillaries, no dysplasia) is diagnostic of duodenal polyp/polyposis in the context of portal hypertension.

The Role of Video Capsule Endoscopy in Liver Disease

In the setting of chronic liver disease, capsule endoscopy is safe and well tolerated, making it an appealing diagnostic procedure. It is used mainly for the surveillance of esophageal varices, investigation of anemia, and exploration of the small bowel for complications of portal hypertension. Capsule endoscopy is recognized as a viable alternative in patients unable or unwilling to undergo upper gastrointestinal endoscopy for investigations of esophageal varices. In evaluating the small bowel of patients with liver disease and unexplained anemia, capsule endoscopy increases recognition of mucosal abnormalities, although their clinical significance is often unclear.

Ectopic duodenal variceal bleed successfully treated with TIPS and 2 years follow-up: A Case Report

Duodenal varices are an uncommon presentation of portal hypertension and can result in significant gastrointestinal bleeding with a high mortality. Diagnosis can be difficult and therapeutic options limited. We present a case of upper gastrointestinal bleeding in a woman aged 54 years with primary biliary cholangitis who was ultimately diagnosed with ectopic duodenal variceal bleed, which was successfully treated with transjugular intrahepatic portosystemic shunt. Transjugular intrahepatic portosystemic shunt provide an effective treatment for ectopic duodenal variceal bleed caused by liver cirrhosis, though interventional radiologists need to remain aware of and vigilant for the complications and risks of this treatment option.

Gastrointestinal Bleeding Secondary to Portal Hypertensive Duodenopathy in a Patient with Decompensated Liver Cirrhosis

With alcoholic cirrhosis and nonalcoholic fatty liver disease continuously on the rise in the United States, there is also a corresponding rise in portal hypertension. Portal hypertensive duodenopathy (PHD) is a complication of portal hypertension not commonly seen in cirrhotic patients. We present a case of a 46-year-old man who presented with decompensated liver cirrhosis secondary to gastrointestinal bleed. The patient underwent esophagogastroduodenoscopy (EGD) with findings indicative of PHD. Patient subsequently underwent transjugular intrahepatic portosystemic shunt (TIPS) with resolution of gastrointestinal bleed. We highlight TIPS as a management strategy in patients with PHD for whom less invasive measures are not effective.

Portal Hypertensive Polyposis in Advanced Liver Cirrhosis: The Unknown Entity?

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.

Duodenal variceal bleed: an unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make

We present a case of recurrent upper gastrointestinal (GI) bleeding in a man aged 57 years with primary biliary cholangitis who was ultimately diagnosed with an isolated duodenal variceal bleed, which was successfully treated with histoacryl glue injection. Duodenal varices are an uncommon presentation of portal hypertension and can result in significant GI bleeding with a high mortality. Diagnosis can be difficult and therapeutic options limited. Endoscopic variceal sclerotherapy with histoacryl glue provides an effective treatment, though endoscopists need to remain aware of and vigilant for the serious complications of this treatment option.