Treatment strategy for patients with cirrhosis complicated by esophageal varices and portal vein thrombosis

Abstract

ABSTRACT

Objective : The optimal treatment strategy for patients with cirrhosis complicated by esophageal varices (EVs) and portal vein thrombosis (PVT) remains unclear. This study evaluated clinical outcomes according to treatment priority.

Methods : We retrospectively analyzed patients with cirrhosis who had PVT confirmed by contrast-enhanced computed tomography before endoscopic injection sclerotherapy for EVs. Patients were categorized into EV-first and PVT-first groups, and changes in thrombus burden and clinical outcomes were compared.

Results : Nineteen patients were included (EV-first, n = 10; PVT-first, n = 9). Baseline thrombus burden was greater in the PVT-first group. Thrombus reduction occurred more frequently in the PVT-first group (10% vs. 100%, p < 0.01). In the EV-first group, the maximum obstruction rate increased significantly (39.5% vs. 69%, p < 0.01), whereas it decreased in the PVT-first group (63% vs. 24%, p = 0.02). No variceal bleeding or other bleeding complications related to anticoagulant therapy or antithrombin III concentrate administration were observed during PVT treatment. After a median follow-up of 24 months, EV recurrence occurred only in the EV-first group and was associated with PVT enlargement.

Conclusions : In this retrospective cohort, favorable thrombus outcomes were observed in patients who underwent PVT-first treatment when variceal therapy could be safely deferred.