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. 2018 Aug 1:2018:2182784.
doi: 10.1155/2018/2182784. eCollection 2018.

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

David Kara  1 , Anna Hüsing-Kabar  1 , Hartmut Schmidt  1 , Inga Grünewald  2 , Gursimran Chandhok  1   3 , Miriam Maschmeier  1 , Iyad Kabar  1
Affiliations

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

David Kara et al. Can J Gastroenterol Hepatol. .

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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Figures

Figure 1
Figure 1
Chronological evolution of a portal hypertensive polyp in one patient after rubber band ligation of esophageal varices between 2014 and 2017 (a-f).
Figure 2
Figure 2
Distribution of gastric polyps with regard to MELD score. Higher MELD score was associated with the presence of hypertensive polyposis of the stomach, suggesting a higher prevalence of gastric polyps in advanced cirrhosis. MELD: Model for End Stage Liver Disease.
Figure 3
Figure 3
Bar chart showing the distribution of portal hypertensive polyposis with regard to rubber band ligation.
Figure 4
Figure 4
Images of hypertensive polyps. (a) Macroscopic aspect of a portal hypertensive antral polyp. (b) Histological image of a hypertensive gastric polyp showing proliferating ectatic vessels (starlets).
See this image and copyright information in PMC

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