Effect of Laparoscopic Splenectomy on Portal Hypertensive Gastropathy in Cirrhotic Patients With Portal Hypertension

Effect of Laparoscopic Splenectomy and Portal Hypertensive Gastropathy

Go Anegawa; Hirofumi Kawanaka; Hideo Uehara; Tomohiko Akahoshi; Kozo Konishi; Daisuke Yoshida; Nao Kinjo; Naotaka Hashimoto; Morimasa Tomikawa; Makoto Hashizume; Yoshihiko Maehara

Disclosures

J Gastroenterol Hepatol. 2009;24(9):1554-1558. 

In This Article

Abstract and Introduction

Abstract

Aim: This study investigated the relationship between portal hypertensive gastropathy (PHG) and splenomegaly, and the effect of laparoscopic splenectomy on PHG in cirrhotic patients with portal hypertension.
Methods: Seventy patients with liver cirrhosis and portal hypertension were prospectively studied. Indication for laparoscopic splenectomy was bleeding tendency in 10 patients, induction of interferon in 45, treatment of hepatocellular carcinoma in seven, and treatment for endoscopic injection sclerotherapy-resistant esophagogastric varices in eight. The severity of PHG was classified into none, mild, or severe according to the classification by McCormack et al. The severity of liver disease was classified using the Child-Pugh score. All patients underwent upper gastrointestinal endoscopy before and 1 month after the operation.
Results: The prevalence of PHG was significantly correlated with the severity of liver disease using the Child-Pugh score. The severity of PHG was significantly correlated with the resected spleen volume. One month after the operation, PHG was improved in 16 of 17 patients with severe PHG and in 12 of 32 with mild PHG. The Child-Pugh score showed a significant improvement (6.8 ± 1.4 to 6.2 ± 1.2) at 3 months after laparoscopic splenectomy (P < 0.0001).
Conclusions: PHG may be associated with splenomegaly, and laparoscopic splenectomy may have a beneficial effect on PHG, at least for a short time.

Introduction

Portal hypertensive gastropathy (PHG) is an endoscopic abnormality of the gastric mucosa that is most commonly observed in patients with advanced liver disease and/or portal hypertension.[1,2] Since the report of McCormack et al. in 1985, the occurrence of these gastric mucosal lesions has been termed congestive gastropathy or PHG.[3] This endoscopic lesion is characterized by the presence of a mucosal mosaic pattern with a snakeskin-like appearance, focal red and brown spots, and vascular ectasia localized in the fundus or body of the stomach.[4] It involves macroscopic changes in the gastric mucosa that occur in portal hypertension, which are associated with mucosal and submucosal vascular dilatation and ectasia without significant inflammatory changes.[3]

Recently, PHG has emerged as a new nosological entity that can be included among the complications of liver cirrhosis, regardless of the low incidence of acute bleeding from PHG.[2,5] Previous reports have shown that the frequency of bleeding was higher in those with severe PHG (38-62%) compared with mild PHG (3.5-31%),[5,6] and a non-selective ß-blocker, such as propranolol, is an effective therapy for PHG.[7,8,9] Portosystemic shunt surgery effectively reduces portal venous pressure and it has been shown to be useful in the treatment of bleeding from PHG.[10] Nonetheless, there are inevitable operative risks in treating advanced liver disease. Recently, a few reports have shown the effect of a transjugular intrahepatic portosystemic shunt (TIPS) on PHG,[11,12] however, there are some complications with portosystemic encephalopathy and shunt dysfunction.

In this study, we aimed to determine: (i) whether splenomegaly is associated with PHG in cirrhotic patients; and (ii) if laparoscopic splenectomy influences the endoscopic findings of PHG.

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