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

UNLABELLED: ABSTRACTObjective : 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.