Two Cases of Gastric Varices with Left-sided Portal Hypertension Due to Essential Thrombocythemia Treated with Gastric Devascularization or Partial Splenic Embolization

Abstract

Left-sided portal hypertension (LSPH) is a condition of extrahepatic portal hypertension that often results in bleeding from isolated gastric varices (GVs). LSPH is sometimes caused by myeloproliferative diseases, such as essential thrombocythemia (ET). We herein report two cases of GVs with LSPH due to ET that were successfully controlled by gastric devascularization (GDS) or partial splenic embolization (PSE). Since each patient with LSPH due to ET has a different pathology, optimal treatment should be performed depending on the patient's condition, such as platelet counts, hemodynamics, or the prognosis. We believe that these cases will serve as a reference for future cases.

Etiologies of Splenic Venous Hypertension: A Review

“…In all cases, patients remained asymptomatic upon follow-up at three or six months (Tables 1D and 2D). 43,44 Primary myelofibrosis (PMF): PMF is a myeloproliferative neoplasm characterized by JAK/STAT pathway activa-tion, leading to a proliferation of myeloid cells and a procoagulatory state predisposing to SVT and subsequent SVH. The estimated prevalence of SVT is reported at 0.6-1.0%.…”

“…45,46,47,76 Similarly, resolution of gastric varices has been achieved by partial splenic embolization or gastric devascularization in patients with ET. 43,44 In both PMF and ET, lifelong anticoagulation is recommended. 42,76 However, the risk versus benefit of anticoagulation in the setting of gastric varices needs to be weighed.…”