Surveillance and Management of Left Portal Hypertension

Introduction to Left Portal Hypertension

• The American Association for the Study of Liver Diseases recommends that patients with left portal hypertension undergo endoscopy to evaluate the presence of gastroesophageal varices 2, 3
• During endoscopy, a detailed description of varices (size, presence of red signs, location) is crucial 1, 4

Risk Factors for Variceal Progression

• The presence of red signs on varices is a risk factor for variceal progression 5
• Ongoing liver damage (e.g., continued alcohol consumption) is a risk factor for variceal progression 5
• A high Child-Pugh score (B or C) is a risk factor for variceal progression 5

Management of Varices

• Primary prophylaxis cannot be systematically recommended in left portal hypertension due to the low risk of bleeding 1, 4
• In case of acute bleeding, treatment should follow standard recommendations for cirrhotic patients (vasoactive drugs, endoscopic ligation, and prophylactic antibiotics) 1, 4
• Non-selective beta-blockers may be less effective in left portal hypertension than in classic portal hypertension due to hypodynamic circulation 1, 4

Special Considerations

• The TIPS (transjugular intrahepatic portosystemic shunt) is not indicated in left portal hypertension but may be considered in highly selected cases of severe uncontrolled variceal bleeding 1, 4
• Endoscopic variceal ligation can be used as primary or secondary prophylaxis, but the risk of deep sedation must be considered 1, 4