THE EVOLUTION OF OESOPHAGEAL VARICES IN NON CIRRHOTIC PORTAL HYPERTENSION CAUSED BY PORTAL VEIN THROMBOSIS

Aims:

The aim of our study is to specify the evolution of oesogastric varices and thus haemorrhagic recurrence risk in patients with portal hypertension (PHT) by portal vein thrombosis (PVT).

Methods:

This is a retrospective study from January 1991 to February 2017, including 163 patients followed for PHT due to PVT without liver disease. PVT was diagnosed by abdominal doppler ultrasonography in all patients.

Results:

The mean age was 34,4 ± 14 years. The sex ratio M/F was 0,49. In all patients, upper GI endoscopy was performed. Hypertensive gastropathy was found in 30.7% (n = 50), Grade I oesophageal varices (OV) in 6% (n = 10), grade II in 30.7% (n = 50), grade III in 47,2% (n = 77) and gastric varices were noted in 14,7% (n = 24). These varices were the site of red signs in 19%. All patients had abdominal doppler ultrasonography showing a PVT in 54,6% (n = 89), this was partial in 31,9% (n = 52), complete in 11.6% (n = 19) and extended to the splenic venous in 11,1% (n = 18). Portal cavernoma was found in 45,4% (n = 74). All patients performed an etiologic assessment of thrombosis, myeloproliferative syndrome was found in 7,3% (n = 12), deficiency in coagulation inhibitor in 31.3% (n = 51), celiac disease in 4,9% (n = 8), neoplasia in 3,7% (n = 6), abdominal surgery in 9,2% (n = 15), pregnancy in 1,2% (n = 2) and no etiology was found in 42% (n = 69). Endoscopic variceal Ligation (EVL) was performed in 65,6% (n = 107), the mean number of ligation sessions was 3 and eradication of varices was noted in 99% (n = 106). All patients received anticoagulant therapy except those having portal cavernoma with no obvious cause. During following up, no bleeding recurrence was noted in 84% (n = 137) and 6% (n = 10) of deaths were reported.

Conclusions:

The evolution of oesophageal varices in portal hypertension due to PVT unrelated to cirrhosis seems to be better than in cirrhotic portal hypertension.