Capsule Endoscopy for Portal Hypertensive Enteropathy

Abstract

Portal hypertensive enteropathy (PHE) is a mucosal abnormality of the small bowel that is observed in patients with portal hypertension (PH) and can lead to gastrointestinal bleeding and anemia. The pathogenesis is still not completely understood. The introduction of new endoscopic methods, including capsule endoscopy (CE) or balloon-assisted enteroscopy, has increased the detection of these abnormalities. CE can also serve as a road map for deciding subsequent interventions and evaluating the treatment effect. The prevalence of PHE is reportedly 40–70% in patients with PH. Endoscopic findings can be roughly divided into vascular and nonvascular lesions such as inflammatory-like lesions. Traditionally, PHE-associated factors include large esophageal varices, portal hypertensive gastropathy or colopathy, Child-Turcotte-Pugh class B or C, a history of variceal treatment, and acute gastrointestinal bleeding. More recently, on using scoring systems, a high computed tomography or transient elastography score was reportedly PHE-related factors. However, the prevalence of PHE and its related associated factors remain controversial. The management of PHE has not yet been standardized. It should be individualized according to each patient's situation, the availability of therapy, and each institutional expertise.

Video Capsule Endoscopy in the Assessment of Portal Hypertensive Enteropathy

“…Most of the information that we have about PHE is from relatively small size studies, both retrospective and prospective. These studies estimated the prevalence to have a wide range between 18% and 100% but the majority of these studies specially the one with large sample size have a narrower range of 65% to 69% [ 8 ]. Our cohort is the largest cohort study in the USA including 100 cirrhotic patients showing that the prevalence of the PHE is 65%, which is similar to the previously published reports [ 5 – 8 ].…”

“…Later in 2008, Kodama et al used double balloon enteroscopy to classify PHE into villous lesions and vascular lesions [ 7 ]. Despite the classifications, there is no gold standard scoring system to differentiate the severity of endoscopic abnormalities found [ 8 ].…”

Small bowel endoluminal imaging (capsule and enteroscopy)

“…SBCE may complement the findings of dedicated SB cross-sectional imaging to identify and help localise SB varices 22. It has also recently been demonstrated that cyanoacrylate and polidocanol injection therapy of SB varices at DAE appears to be a safe and effective management strategy for this condition when other first-line options such as radiological intervention (TIPSS, stenting of occluded mesenteric veins ±embolisation of culprit varices) are not feasible 23…”

The Usefulness of New-Generation Capsule Endoscopy in Patients with Portal Hypertensive Enteropathy

“…Portal hypertension (PH) is a clinical syndrome of pathologically elevated portal systemic pressure, which is a hepatic venous pressure gradient of >5 mm Hg [1,2]. It is caused by increased hepatic vascular resistance and increased portal inflow due to splanchnic vasodilatation.…”

“…Currently, no standard therapeutic guideline exists for symptomatic PHE. Balloon-assisted enteroscopy, radiological interventions such as transjugular intrahepatic portosystemic shunt placement or percutaneous coil embolization, and surgery may be used [1]. The relevant endoscopic procedures include argon plasma coagulation, hemoclipping, polypectomy, and variceal injection sclerotherapy.…”