CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(03): E292-E299
DOI: 10.1055/s-0043-124363
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Endoscopic ultrasound assessment of gastrointestinal polypoid lesions of indeterminate morphology in patients with portal hypertension

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
› Author Affiliations
Further Information

Publication History

submitted 17 April 2017

accepted after revision 25 October 2017

Publication Date:
01 March 2018 (online)

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.