A Study of Portal Hypertensive Polyps

Abstract

Background: Portal hypertension induces mucosal changes like portal hypertensive gastropathy, duodenopathy and colonic mucosal abnormalities. These polyps are commonly found in the stomach than other parts of bowel. Portal hypertensive polyp usually occur in cirrhotic portal hypertension and are also in extra hepatic portal vein occlusion. Diagnostic criteria for portal hypertensive polyp is not yet clearly described. Hence it becomes essential to evaluate the prevalence of polyps in portal hypertensive patients. The aim was to estimate the prevalence of portal hypertensive polyps in patients with portal hypertension due to any etiology.Methods: This is a prospective observational study of patients with portal hypertensive polyps. All patients in age group of 18 to 80 years who had portal hypertension diagnosed by clinical, laboratory and imaging criteria who went upper gastro intestinal endoscopy from the period of May 2012 to April 2013 were included in the study. Diagnosis of portal hypertensive polyps was confirmed histologically. Patients with proton pump inhibitor use, gastric varices, h. pylori gastritis, history of inherited polyposis syndromes, patients who refused consent were excluded.Results: A total of 3,621upper GI endoscopies were done of which 428 patients had portal hypertension. Polyps were noted in 9 patients (2.1%). Out of 428 patients 366 had chronic liver disease and 62 had extrahepatic portal hypertension and out of them 1 was excluded due to Rapid urease test positivity. Histopathological examination showed four had extensive vascular proliferation and glandular hyperplasia (portal hypertensive polyp) two had hyperplastic polyp and other two had neuroendocrine tumour. Endoscopic appearances of polyps varied considerably, with sizes ranging from 5mm to 15 mm. Polyps were sessile or pedunculated, singular or multiple, found in the antrum, body of the stomach .There is no specific endoscopic features to identify portal hypertensive polyps.Conclusions: Portal hypertensive polyps are rare. There is no specific endoscopic features. Biopsy is necessary for diagnosis. Longterm studies are needed to characterise their significance.