Skip to main content
SpringerLink
Log in

Characteristic endoscopic features of portal hypertensive enteropathy

  • Alimmentary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Double-balloon endoscopy (DBE) and capsule endoscopy have opened up a new field of investigation regarding the small intestine. Although DBE has been widely used for diagnosis and treatment of different lesions in the small intestine, there is a paucity of information regarding endoscopic features of the small intestine in patients with liver cirrhosis (LC).

Methods

Endoscopic images of the small intestine were taken in 21 patients with LC by DBE (EN-450P5/20 or EN-450T5/W). Biopsy specimens were taken from various parts of the small intestine and examined microscopically. Different endoscopic features of the small intestine were compared in relation to the clinical parameters of these patients.

Results

Erythema and telangiectasia were observed in five patients (24%) and one patient (5%), respectively. In eight patients (38%), the small intestinal mucosa was edematous, and the intestinal villi of these patients were swollen and rounded, resembling herring roe. The patients with a herring roe appearance in the small intestine had advanced LC (Child’s classification B and C), and all of them also had portal hypertensive gastropathy and portal hypertensive colopathy. In comparison with patients without a herring roe appearance in the small intestine, patients with a herring roe appearance had a significantly increased spleen volume (P < 0.05) and decreased platelet counts (P < 0.05).

Conclusions

Although preliminary, this study indicated that DBE may be useful for detecting different types of endoscopic lesions in patients with LC. A herring roe appearance seems to be one of the characteristic features of portal hypertensive enteropathy. However, further study will be required to develop insights about its pathogenesis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sarfeh IJ, Tarnawaski A. Gastric mucosal vasculopathy in portal hypertension. Gastroenterology 1987;93:1129–1131.

    PubMed  CAS  Google Scholar 

  2. Viggiano TR, Gostout CJ. Portal hypertensive intestinal vasculopathy: a review of the clinical, endoscopic, and histopathologic features. Am J Gastroenterol 1992;87:944–954.

    PubMed  CAS  Google Scholar 

  3. Kozarek RA, Botoman VA, Bredfeldt JE, Roach JM, Patteson DJ, Ball TJ. Portal colopathy: prospective study of colonoscopy in patients with portal hypertension. Gastroenterology 1991;101:1192–1197.

    PubMed  CAS  Google Scholar 

  4. Misra SP, Dwivedi M, Misra V, Gupta M. Ilial varices and portal hypertensive ileopathy in patients with cirrhosis and portal hypertension. Gastrointest Endosc 2004;60:778–783.

    Article  PubMed  Google Scholar 

  5. Giovanni D, De Palma, Rega M, Masone S, Persico F, Siciliano S, et al. Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: a capsule endoscopy study. Gastrointest Endosc 2005;62:529–534.

    Article  Google Scholar 

  6. Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001;53:216–220.

    Article  PubMed  CAS  Google Scholar 

  7. Yamamoto H, Yano T, Kita H, Sunada K, Ido K, Sugano K. New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders. Gastroenterology 2003;125:1556–1557.

    Article  PubMed  Google Scholar 

  8. Manabe N, Tanaka S, Fukumoto A, Nakao M, Kamino D, Chayama K. Double-balloon enteroscopy in patients with GI bleeding of obscure origin. Gastrointest Endosc 2006;64:135–140.

    Article  PubMed  Google Scholar 

  9. Monkemuller K, Fry LC, Malfertheiner P. Double-balloon enteroscopy: beyond feasibility, what do we do now? Endoscopy 2007;39:229–231.

    Article  PubMed  CAS  Google Scholar 

  10. Zhong J, Ma T, Zhang C, Sun B, Chen S, Cao Y, et al. A retrospective study of the application on double-balloon enteroscopy in 378 patients with suspected small-bowel diseases. Endoscopy 2007;39:208–215.

    Article  PubMed  CAS  Google Scholar 

  11. Monkemuller K, Fry LC, Ebert M, Bullutti M, Venerito M, Knipping C, et al. Feasibility of double-balloon enteroscopy-assisted chromoendoscopy of the small bowel in patients with familial adenomatous polyposis. Endoscopy 2007;39:52–57.

    Article  PubMed  CAS  Google Scholar 

  12. Oshitani N, Yukawa T, Yamagami H, Inagawa M, Kamata N, Watanabe K, et al. Evaluation of deep small bowel involvement by double-balloon enteroscopy in Crohn’s disease. Am J Gastroenterol 2006;101:1484–1489.

    Article  PubMed  Google Scholar 

  13. Rana SS, Bhasin DK, Jahagirdar S, Raja K, Nada R, Kochhar R, et al. Is there ileopathy in portal hypertension? Gastroenterol Hepatol 2006;21:392–397.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, 791-0295, Japan

    Naoyuki Higaki, Hidetaka Matsui, Hiroya Imaoka, Yoshiou Ikeda, Hidehiro Murakami, Yoichi Hiasa, Bunzo Matsuura & Morikazu Onji

Authors
  1. Naoyuki Higaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidetaka Matsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroya Imaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshiou Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hidehiro Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoichi Hiasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bunzo Matsuura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Morikazu Onji
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Higaki, N., Matsui, H., Imaoka, H. et al. Characteristic endoscopic features of portal hypertensive enteropathy. J Gastroenterol 43, 327–331 (2008). https://doi.org/10.1007/s00535-008-2166-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-008-2166-9

Key words

Search

Navigation