New Classification of Gastric Varices: A Twenty-Year Experience

Objectives Gastric varices (GV) have been classified by the Sarin classification for over two decades. However, a subset of these varices does not fit into this classification. We share our experience on GV in past 20 years and propose a modification. Materials and Methods Consecutive patients with portal hypertension (PHT) posted for esophagogastroduodenoscopy were screened for GV between 1996 and 2016 at a tertiary-care hospital. GV were categorized as gastroesophageal varices (GOV1, GOV2) and isolated gastric varices (IGV1, IGV2) by Sarin’s classification. Patients with varices in esophagogastric region as well as distally in the stomach or duodenum, thus having efferent drainage into the superior as well as inferior vena cava simultaneously, remain unclassified and were coined as GOV3. Statistical Analysis Descriptive data was represented as mean (standard deviation) or median (interquartile range) or number (percentage). Chi-squared test, t-test, and logistic regression were done to compare groups and identify outcomes of interest. Results GV were recognized in 400 (11.5%) of 3,476 patients with PHT. Underlying disease was cirrhosis in 301 (75.2%), extrahepatic portal venous obstruction in 78 (19.5%), noncirrhotic portal fibrosis in 18 (4.5%) and Budd–Chiari syndrome in 3 (0.75%) patients with GV. GOV1, GOV2, IGV1, IGV2, and combined GOV1 with GOV2 were seen in 170 (42.5%), 154 (38.5%), 17 (4.3%), 5 (1.3%), and 12 (3.0%) patients; respectively. GOV3 were identified in 42 (10.5%) patients. Ninety-three patients with GV presented with gastrointestinal bleed and frequency of GOV2 was higher and GOV1 and GOV3 were lower among bleeders than non-bleeders. Conclusions A significant proportion of patients with GV remain uncategorized by current classification among PHT patients. Addition of GOV3 in Sarin’s classification will make it more comprehensive, uniform, and reproducible for future studies.

Pregnancy Complicated by Portal Hypertension Secondary to Noncirrhotic Portal Fibrosis

ABSTRACT Noncirrhotic portal fibrosis (NCPF) is a liver disorder characterized by periportal fibrosis of small and medium branches of portal vein resulting in portal hypertension with the sequelae of variceal bleed requiring immediate attention. We report a case of 27-years-old primigravida with NCPF presented for her booking visit with 3 months of amenorrhea. Clinical examination and ultrasound revealed 12 weeks of intrauterine gestation with moderate splenomegaly, dilated portal vein, and splenic vein. The patient was referred to medical gastroenterologist. Hematological investigations were found normal except for borderline thrombocytopenia. Upper gastrointestinal endoscopy revealed grade I esophageal varices. She was monitored bimonthly by obstetrician and hepatologist as she was potential for variceal bleed, anemia, liver derangement, and coagulation abnormalities during antenatal and intrapartum period. She had well-preserved liver function throughout pregnancy and no variceal bleed. Fetal surveillance was done and she received prophylactic corticosteroids at 28 weeks of gestation for fetal lung maturation. Antenatal period was uneventful. In view of breech presentation, elective cesarean section was performed and a healthy male baby was delivered weighing 2.9 kg, with good Apgar score. Intrapartum and postpartum period was uneventful. Surveillance by a multidisciplinary team is important for such high-risk pregnancy for optimizing obstetric and neonatal care. How to cite this article Niroopama P. Pregnancy Complicated by Portal Hypertension Secondary to Noncirrhotic Portal Fibrosis. J South Asian Feder Obst Gynae 2017;9(1):63-65.

An Unusual Case of Gastrointestinal Bleeding from Isolated Gallbladder Varices in a Patient with Pancreatic Cancer Complicated by Portal Biliopathy

Portal biliopathy is the complex of abnormalities of extrahepatic and intrahepatic bile ducts, cystic duct, and gallbladder, arising as a result of extrahepatic portal vein obstruction and noncirrhotic portal fibrosis, which can be caused by coagulopathies, tumors, inflammation, postoperative complications, dehydration, and neonatal umbilical vein catheterization. We report a case of a 55-year-old male patient with the history of pancreatic cancer and cholecystoenteric anastomosis presenting with gastrointestinal bleeding from gallbladder varices via the anastomosis.

Pulmonary Cavity due to Chronic Eosinophilic Pneumonia Associated with Arsenicosis

In developing country like India arsenic poisoning is a major public health problem. Association of chronic eosinophilic pneumonia and chronic diarrhea with arsenicosis is rare. Also pulmonary cavity formation in chronic eosinophilic pneumonia is very uncommon. A 44-year-old male patient, resident of an arsenic affected area was admitted for evaluation of chronic diarrhoea, persistent peripheral eosinophilia along with radiologically visible cavity in right upper zone. There were dermatological manifestations of arsenicosis along with presence of noncirrhotic portal fibrosis and peripheral eosinophilia. On bronchoalveolar lavage study, eosinophil comprised 40% of total cellularity making the diagnosis of chronic eosinophilic pneumonia. After ruling out all possible causes of diarrhoea and chronic eosinophilic pneumonia, we came to conclusion that arsenic could be implicated as causative agent. Keywords: Arsenicosis, chronic diarrhoea, chronic eosinophilic pneumonia, noncirrhotic portal fibrosis.