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Revista Española de Enfermedades Digestivas

Print version ISSN 1130-0108

Rev. esp. enferm. dig. vol.108 n.5 Madrid May. 2016




Portal hypertensive polyps, a new entity?

Pólipos de la hipertensión portal, ¿una nueva entidad?



Verónica Martín-Domínguez1, Ariel Díaz-Menéndez2, Cecilio Santander1 and Luisa C. García-Buey1

1 Department of Gastroenterology. CIBEREHD. IIS-IP. Autonomous University of Madrid.
2 Department of Pathology. Hospital Universitario de La Princesa (HULP). Madrid, Spain




Presentamos el caso clínico de una mujer de 62 años de edad, con antecedentes de cirrosis hepática secundaria a hepatitis autoinmune, hipertensión portal y coagulopatía, quien presenta en gastroscopia, unas lesiones polipoideas, semipediculadas, polilobuladas en la región prepilórica, que se extirpan y cuya anatomía patológica se describe como pólipos hiperplásicos con edema, congestión vascular e hiperplasia del músculo liso, sin displasia ni cambios adenomatosos, correspondientes a "pólipos de la hipertensión portal" (PHP).


Case Report

We report the case of a 62-year-old woman with a history of liver cirrhosis secondary to autoimmune hepatitis, portal hypertension and coagulopathy. Gastroscopy was performed to discard esophageal varices. In the gastric antrum a multiple polypoid and polylobed lesions were observed, occupying prepyloric region and extending into the pylorus and duodenal bulb (Fig. 1). Ultrasonography was performed to confirm absence of varices at that level. The larger lesions (8, 10, 12 mm) were removed with snare and thermocoagulation. Hemostasis security (hemoclips) was placed to reduce the risk of delayed bleeding. Pathological study described gastric hyperplastic polyps with edema, vascular congestion and smooth muscle hyperplasia without dysplasia or adenomatous changes (Fig. 2).





Portal hypertensive polyps (PHP) are a recent entity, described in cirrhotic patients with portal hypertension, portal venous obstruction or antral vascular ectasia. These lesions are similar to hyperplastic polyps, but with subepithelial vascular alterations histological features. Its prevalence ranges from 1-3% (1,2). The pathogenic mechanism is unknown, but is believed to be due to increased gastric angiogenesis (3). Endoscopic image may suggest malignant lesions such as gastric adenocarcinoma, even submucosal tumor lesions. Usually asymptomatic, but in rare cases, they can cause anemia, gastrointestinal bleeding and gastric outlet obstruction, due to their antral location (4). Some authors recommend a similar management to that of hyperplastic polyps with endoscopic follow-up of asymptomatic, avoiding the complications of polypectomy (2,4). Because the risk of malignant transformation is unknown, some authors recommend resection of the ones over 5 mm (2,5). Complications of endoscopic resection are frequent bleeds and perforations (4).



1. Lam MC, Tha S, Owen D, et al. Gastric polyps in patients with portal hypertension. Eur J Gastroenterol Hepatol 2011;23:1245-9. DOI: 10.1097/MEG.0b013e32834c15cf.         [ Links ]

2. Pai CG. Portal hypertensive polyp - what is in a name? Indian J Gastroenterol 2013;32:163-4. DOI: 10.1007/s12664-013-0331-4. DOI: 10.1007/s12664-013-0331-4.         [ Links ]

3. Amarapurkar AD, Amarapurkar D, Choksi M, et al. Portal hypertensive polyps: Distinct entity. Indian J Gastroenterol 2013;32:195-9. DOI: 10.1007/s12664-013-0324-3.         [ Links ]

4. Aydin I, Ozer E, Rakici H, et al. Antral hyperplastic polyp: A rare cause of gastric outlet obstruction. Int J Surg Case Rep 2014;5:287-9. DOI: 10.1016/j.ijscr.2014.03.016.         [ Links ]

5. Muchldorfer SM, Stolte M, Martus P, et al. Diagnostic accuracy of forceps biopsy versus polypectomy for gastric polyps: A prospective multicentre study. Gut 2002;50:465-70. DOI: 10.1136/gut.50.4.465.         [ Links ]