Clinical parameters associated with gastric portal hypertensive polyps

Abstract

Objectives

Portal hypertensive polyps (PHPs) are incompletely characterized lesions that can be found in the distal stomach of patients with portal hypertension. We aimed to delineate clinical factors associated with the appearance of these rare polyps.

Material and methods

We conducted a cross-sectional study of a cohort with 513 cirrhotic patients comparing patients with and without PHP using descriptive analyses and multivariable logistic regression. To address the problem of missing values, in particular for HVPG and liver stiffness, we used multiple imputation of missing values.

Results

The prevalence of macroscopically diagnosed PHP was 3.3% (95% confidence interval 2.0 − 5.4%). In 53% of cases, the correct classification was missed on index gastroscopy. Patients with PHP were older at gastroscopy (65 years vs. 59), had higher hepatic venous pressure gradients (HVPG, 28 mmHg vs. 19 mmHg), higher transient elastography (TE) measurements (50.7 kPa vs. 21.8 kPa) and more often had previous rubber band ligations (RBL, 64.7% vs. 25.8%). The multivariable logistic regression on the outcome macroscopically diagnosed PHP estimated an odds ratio (OR) for HPVG of 1.13 (CI 0.95–1.34), increased liver stiffness of 1.03 (1.00 − 1.07) and previous RBL of 3.84 (1.24 − 11.88), respectively.

Conclusion

The prevalence of PHPs in the stomach was higher than assumed in previous studies and misclassification was commonly observed. The appearance of these rare polyps is associated with previous RBL and may correlate with severity of PH. Thus, PHPs may be regarded as marker for relevant PH, but clinical significance of these polyps is still uncertain.

Keywords:

• Portal hypertensive polyp
• portal hypertension
• HVPG
• elastography
• cirrhosis

Author contributions

Study concept and design: Florian Hildenbrand, Stefanie von Felten, Bernhard Morell, Christoph Gubler. Acquisition of data: Chantal Wohlwend, Bernhard Morell, Florian Hildenbrand, Christoph Gubler, Simon Bütikofer, Frans Olivier The, Fritz Murray. Analysis and interpretation of data: Stefanie von Felten (analysis), Bernhard Morell, Florian Hildenbrand, Stefanie von Felten, Fritz Murray, Ann-Katrin Rodewald, Christoph Gubler (interpretation). Drafting of manuscript: Florian Hildenbrand, Bernhard Morell, Critical revision of manuscript: Simon Bütikofer, Fritz Murray, Frans Olivier The, Stefanie von Felten, Christoph Gubler, Bernhard Morell, Chantal Wohlwend, Florian Hildenbrand, Ann-Katrin Rodewald.

Compliance with ethical standards

We (the authors) have nothing to disclose. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Disclosure statement

The authors have no conflict of interest to declare.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request: [email protected]

Additional information

Funding

The study was financially supported by the Division of Gastroenterology and Hepatology, University Hospital Zürich.