Is endoscopic management of oesophageal varices in extrahepatic portal venous obstruction (EHPVO) a risk factor for portal biliopathy

Introduction: There are no data on the risk factors for development of portal biliopathy (PB). We did a case-control study to ascertain the risk factors for occurrence of PB in patients with EHPVO. Methods: The records extracted from a prospectively maintained database of all patients with portal hypertension due to EHPVO presenting to the department of GI surgery AIIMS, New Delhi , between January 1976 and January 2013, were screened for the presence of PB. A group of sex-matched controls who did not have evidence of PB at the time of presentation were selected from the EHPVO database for comparison, in order to identify the factors associated with the development of PB. Results: Between January 1976 and January 2013, 1027 patients were diagnosed to have EHPVO and underwent a surgical procedure for portal hypertension at our centre. PB was diagnosed in 134 (13%) patients, of whom 74 (55.2%) were symptomatic.Incidence of PB was 36 patients over a five year period from 2003 to 2007 but doubled to 72 over the next five years. On logistic regression between the group of 134 sex-matched controls who did not have evidence of PB, absence of gastrointestinal bleeding, incidence of endoscopic therapy for oesophageal varices and absence of high grade oesophageal varices at the time of diagnosis were found to be associated with PB (p < 0.001; Table I).Tabled 1Table 1Risk FactorsPB n=134(%)Controls n=134(%)P valueOdds ratio (95% CI)Gastrointestinal bleed100 (74.6)123 (91.8)<0.0010.14 (0.06–0.33)Endotherapy83 (61.9)48 (35.8)<0.0013.3 (1.75–6.3)High grade varices39/128 (30.5)94/132 (71.2)<0.0010.24 (0.13–0.42) Open table in a new tab Conclusion: Endoscopic Obliteration of varices or absence of high grade varices may be a predisposing risk factor for development of PB in patients with EHPVO.