Profile of Patients With Extrahepatic Portal Vein Obstruction in a Tertiary Care Centre of Eastern India

Abstract

Introduction: Extrahepatic portal venous obstruction (EHPVO) is an important cause of Portal hypertension. There is few data regarding EHPVO in eastern India. Patients of EHPVO diagnosed on USG and Colour Doppler study were evaluated for age of presentation, mode of therapy and outcome. Methods: Consecutive EHPVO cases attending the Department of Gastroenterology of a tertiary care centre in eastern India, from August 2014 to July 2017 were included in the study. Results: Out of total 118 EHPVO patients, males predominantly affected; (Male: Female ratio—1.56:1). Median age at the time of diagnosis, and onset of upper gastrointestinal (UGI) bleed were 16.5 years (IQR 6.75-30 years) and 17.5 years (IQR 8-30 years) respectively. UGI bleed was the presenting manifestation in 88.13% patients; whereas 74.1% cases required blood transfusion. Jaundice was present in 20.3% of cases and 6.8% cases developed ascites following bleed. Mean frequency of UGI bleed and blood transfusion requirement were 2±1.05 times and 1.64±1.2 units annually respectively. History of umbilical sepsis and growth retardation was present in 25% and 15.3% cases respectively. Out of 46 female cases, 22% had successful pregnancy. Splenomegaly was present in 86.2% of cases and portal bilopathy in 5.5% while only 10.2% had undergone splenectomy and 3.4% had shunt surgery. Esophageal varices were present in 96.5% patients but only 29.8% patients had gastric varices. Portal hypertensive gastropathy was seen in 22.8% cases. 67.8% cases received endotherapy [80% (sclerotherapy), 20% (band ligation)]; whereas complete sclerosis of varices occurred only in 17.4% cases. 5.3% cases had gastric variceal bleed and undergone glue injection. 24.1% cases progressed to cirrhosis after a median duration of 4 (1-28) years. 1.8% cases expired due to massive UGI bleed. Beta-blocker therapy was given to 56.1% of cases out of which 70% responded. Conclusion: EHPVO is an important cause of portal hypertension in eastern India. Most cases could be managed with endoscopic therapy in a tertiary care hospital.