Characteristic endoscopic features of portal hypertensive enteropathy

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).

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.

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).

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.