In the Journals

Gastroesophageal variceal bleeding common in patients with PVT

Gastroesophageal variceal bleeding was common in patients with portal vein thrombosis without cirrhosis. The progression of varices at high risk for bleeding were similar to the development of varices in patients with cirrhosis.

To determine if the recommended strategy for endoscopic screening and management of varices of patients with cirrhosis should apply to patients with chronic portal vein thrombosis (PVT) without cirrhosis, researchers evaluated data of 326 patients with PVT from two referral centers for vascular disorders of the liver in Barcelona, Spain and Paris, France. The final analysis included 178 patients. The median follow-up was 49 months.

Variceal bleeding was the first manifestation in 15% of patients (n = 27). Initial endoscopy in the other patients showed 34% had no varices (n = 52), 19% had small esophageal varices (n = 28), 40% had large esophageal varices (LEV; n = 60) and 7% had gastric varices without LEVs (n = 11).

Analyses showed ascites and splenomegaly were independent predictors for the presence of varices. In patients without varices, the probability for development was 2% at 1 year, 22% at 3 years and 22% at 5 years.

In those with small esophageal varices, growth to LEVs was observed in 13% of patients at 1 year, 40% at 3 years and 54% at 5 years. In patients with LEVs on primary prophylaxis, the probability of variceal bleeding was 9% at 1 year, 20% at 3 years and 32% at 5 years.

Five percent of patients died after a median of 51 months. Only one of the patient deaths was due to variceal bleeding. Actuarial probability of survival was 99% at 1 year, 98% at 3 years and 96% at 5 years. Age, altered liver enzymes and the presence of ascites at baseline were associated with mortality, according to univariate Cox regression analysis.

“[Gastroesophageal varices] are especially frequent in patients with ascites, even detected only at imaging studies or with splenomegaly,” the researchers wrote. “Varices at high risk of bleeding are infrequent but not rare in the absence of these two factors. Most progression, indicated by development of varices in patients without varices at diagnosis and variceal growth in patients with small varies, takes place early in the course of PVT.”

The researchers added that the risk for first variceal bleeding on primary prophylaxis and for rebleeding in these patients were also similar to those observed in patients with cirrhosis, based on similar therapeutic approaches. – by Melinda Stevens

Disclosure: Ferreira reports no relevant financial disclosures. Please see the study for all other researchers’ relevant financial disclosures.

Gastroesophageal variceal bleeding was common in patients with portal vein thrombosis without cirrhosis. The progression of varices at high risk for bleeding were similar to the development of varices in patients with cirrhosis.

To determine if the recommended strategy for endoscopic screening and management of varices of patients with cirrhosis should apply to patients with chronic portal vein thrombosis (PVT) without cirrhosis, researchers evaluated data of 326 patients with PVT from two referral centers for vascular disorders of the liver in Barcelona, Spain and Paris, France. The final analysis included 178 patients. The median follow-up was 49 months.

Variceal bleeding was the first manifestation in 15% of patients (n = 27). Initial endoscopy in the other patients showed 34% had no varices (n = 52), 19% had small esophageal varices (n = 28), 40% had large esophageal varices (LEV; n = 60) and 7% had gastric varices without LEVs (n = 11).

Analyses showed ascites and splenomegaly were independent predictors for the presence of varices. In patients without varices, the probability for development was 2% at 1 year, 22% at 3 years and 22% at 5 years.

In those with small esophageal varices, growth to LEVs was observed in 13% of patients at 1 year, 40% at 3 years and 54% at 5 years. In patients with LEVs on primary prophylaxis, the probability of variceal bleeding was 9% at 1 year, 20% at 3 years and 32% at 5 years.

Five percent of patients died after a median of 51 months. Only one of the patient deaths was due to variceal bleeding. Actuarial probability of survival was 99% at 1 year, 98% at 3 years and 96% at 5 years. Age, altered liver enzymes and the presence of ascites at baseline were associated with mortality, according to univariate Cox regression analysis.

“[Gastroesophageal varices] are especially frequent in patients with ascites, even detected only at imaging studies or with splenomegaly,” the researchers wrote. “Varices at high risk of bleeding are infrequent but not rare in the absence of these two factors. Most progression, indicated by development of varices in patients without varices at diagnosis and variceal growth in patients with small varies, takes place early in the course of PVT.”

The researchers added that the risk for first variceal bleeding on primary prophylaxis and for rebleeding in these patients were also similar to those observed in patients with cirrhosis, based on similar therapeutic approaches. – by Melinda Stevens

Disclosure: Ferreira reports no relevant financial disclosures. Please see the study for all other researchers’ relevant financial disclosures.