Gastric antral polyps: a manifestation of portal hypertensive gastropathy

Panackel, Charles; Joshy, Harshad; Sebastian, Benoy; Thomas, Renu Mariam; Mathai, Sunil

doi:10.1007/s12664-013-0313-6

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…Gastric and duodenal hypertension has been associated with the presence of portal hypertensive polyps, but this has mostly been reported in case reports and a few small case series [ 5 – 10 , 12 – 15 ]. In our study, we comprehensively evaluated the clinical appearance of PHP.…”

Section: Discussionmentioning

confidence: 99%

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

Kara

Hüsing‐Kabar

Schmidt

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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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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Section: Discussionmentioning

confidence: 99%

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

Kara

Hüsing‐Kabar

Schmidt

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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“…In recent years, a distinct type of polypoid lesions in the context of PH has also been reported in both pediatric 4 and adult population 5 . Location of these lesions varies in different reports, but are more commonly seen in the duodenum, small bowel 6 7 8 and stomach 5 9 10 11 12 13 . There is no consensus on the terminology used to describe such lesions and various terms including “gastric polyposis associated with portal hypertension” 11 or “portal hypertension-associated gastric polyps” 9 have been proposed.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…Neoplastic lesions such as adenomas and vascular lesions such as gastric varices need to be ruled out. Also, some reports have implicated PHP in continuing blood loss after eradication of varices though the data provided are insufficient to conclude this definitely [2,4,6]. Given their small size, they may not cause obstructive symptoms, which anyway are uncommon with gastroduodenal polyps.…”

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confidence: 99%

“…The latest entry to this slowly lengthening list of abnormalities is the 'portal hypertensive polyp' (PHP), described in two reports in the current issue of this Journal [1,2]. As with any newly described entity, a bevy of questions immediately comes up.…”

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confidence: 99%

“…In a retrospective study from Canada, only 12 cases were identified over 20 years [3]. The two studies under review, only one of them prospective, found PHP in 1.01 % to 2.53 % of patients undergoing upper endoscopy for PH over 15-33 months [1,2]. PHP are, therefore, not really uncommon, and while gastroscopy has been a routine diagnostic procedure in PH for decades now, PHP has clearly remained unappreciated till recently.…”

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confidence: 99%

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Portal hypertensive polyp—what is in a name?

Pai

2013

Indian J Gastroenterol

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Draining as it does into the portal venous system, it is not surprising that most of the gastrointestinal tract should show a variety of changes in portal hypertension (PH). The latest entry to this slowly lengthening list of abnormalities is the 'portal hypertensive polyp' (PHP), described in two reports in the current issue of this Journal [1, 2]. As with any newly described entity, a bevy of questions immediately comes up.PHP have been reported to occur in the stomach and less commonly elsewhere in the bowel [3,4]. They have most often been associated with cirrhotic PH but do occur in extrahepatic portal venous obstruction too [5]. Are they a distinct entity? The reports under review, dealing with gastric and duodenal lesions, and a handful of preceding ones make a case that they are. However, there have been no clear diagnostic criteria for PHP. Microscopically, gastric PHP have been diagnosed based on the presence of variable foveolar hyperplasia of the epithelium along with underlying vascular proliferation. So the question arises: are these lesions unique to PH or do they simply represent hyperplastic polyps arising on a background of vascular changes of PH such as portal hypertensive gastropathy (PHG) or gastric antral vascular ectasia (GAVE)? The latter possibility certainly cannot be ruled out. In their retrospective analysis, on 631 patients with PH, Amarapurkar et al. found gastric and duodenal polyps in 16 (2.53 %) patients. Nine of these were diagnosed as PHP, six as hyperplastic polyp, and one as fundic gland polyp. On comparing PHP with PHG mucosa devoid of polyps, the authors found that the density and diameter of capillaries in the lamina propria were similar but that such changes were significantly more frequent (p<0.001) in these two groups compared to polyps in patients without PH. The morphometric and special staining characteristics of PHP presented in the paper do not provide any support to the contention that the vascular changes seen in PHP are distinct from those seen in PHG or GAVE. Nor does the comparison, less detailed nonetheless, between hyperplastic polyps and PHP as reported by Lam et al. in an earlier report confirms that these two lesions are distinct. Did the six hyperplastic polyps reported by Amarapurkar et al. differ from the PHP in any characteristics other than the vascularity? The paper does not comment on this. Again, there was no difference in the age, gender, the frequency of polyps, and their histological types in the portal hypertensive and non-portal hypertensive groups. The fact that the prevalence of all types of polyps in the portal hypertensive and non-portal hypertensive group (2.53 % vs. 3.3 %, p=0.4) was similar also casts doubts as to whether these are unique lesions developing in the presence of PH over and above the other types of polyps seen in the general population. Also, PHP in the stomach and those in the small bowel may not show similar histological features except for the increased, dilated subepithelial capillaries. For example, some earlier repo...

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Gastric antral polyps: a manifestation of portal hypertensive gastropathy

Cited by 7 publications

References 9 publications

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

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

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

Portal hypertensive polyp—what is in a name?

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