Endoscopic/Radiologic Management of Nonvariceal Portal Hypertensive Bleeding

Nonvariceal portal hypertensive bleeding is bleeding in the gastrointestinal tract caused by PHT, but not from esophageal or gastric varices. Instead, it involves bleeding from other sources within the digestive system due to increased pressure in the portal vein system. The four most common types of nonvariceal portal hypertensive bleeding include: ‹

Portal hypertensive gastropathy (PHG): It is attributed as the cause of 4% of all acute bleeding in chronic liver diseases (CLD). A study has shown that transjugular intrahepatic portosystemic shunt (TIPS) can improve the endoscopic appearance of PHG lesions in 6 to 12 weeks, with reduced transfusion requirements. ‹

Gastric antral vascular ectasia (GAVE): In argon plasma coagulation (APC) treatment of GAVE, more profound mucosal injuries must be avoided. Additionally, studies have shown that the recurrence-free rate following this treatment is 50% for 1 year and 35% for 3 years. In the case of APC-refractory GAVE, the RFA treatment method can be used as it yields comparable results to APC. Endoscopic variceal ligation (EVL) is superior to APC and RFA treatment of GAVE with a success rate of 81% to 87.8%. TIPS is not effective for treating GAVE ‹

Portal hypertensive duodenopathy (PHD): The frequency of PHD among cirrhosis patients with esophageal varices is 14%. This condition can be treated with TIPS and APC. ‹

Portal hypertensive colopathy (PHC): This chronic condition has a 3% to 71% prevalence in cirrhosis patients. Although bleeding from PHC is uncommon, it is seen in 0% to 9% of cases.

Some of the additional key points to remember are:

• PHG, PHD and PHC are poorly defined entities with an unclear clinical correlation.
•  There is a dearth of data on the frequency and significance of bleeding from PHTrelated nonvariceal sources. ‹
•  Treatment for bleeding from PHG, PHD and PHC should be individualized