Extrahepatic Portal Venous Obstruction: Revisiting an Old Entity With NewPerspectives

Area of Science:

• Gastroenterology and Hepatology
• Vascular Surgery
• Pediatric Gastroenterology

Background:

• Extrahepatic portal venous obstruction (EHPVO) is a significant cause of non-cirrhotic portal hypertension, particularly in developing countries.
• It is characterized by chronic portal vein thrombosis leading to complications like variceal bleeding and portal biliopathy.
• EHPVO disproportionately affects children and adolescents.

Purpose of the Study:

• To review and synthesize current evidence on the epidemiology, pathogenesis, diagnosis, and treatment of EHPVO.
• To highlight recent advances in endovascular recanalization techniques for managing EHPVO.
• To provide updated perspectives on managing portal cavernoma cholangiopathy and differentiate pediatric versus adult treatment priorities.

Main Methods:

• Comprehensive literature review of recent studies on EHPVO.
• Synthesis of evidence on diagnostic imaging and interventional techniques.
• Analysis of contemporary endovascular recanalization strategies and management of portal biliopathy.

Main Results:

• EHPVO remains a critical health issue in tropical regions, impacting pediatric and adult populations.
• Endovascular recanalization techniques have shown promise in managing EHPVO complications.
• Updated approaches to portal cavernoma cholangiopathy management are emerging.

Conclusions:

• EHPVO requires tailored management strategies, with distinct considerations for pediatric and adult patients.
• Endovascular interventions represent a significant advancement in treating EHPVO and its sequelae.
• Further research and updated guidelines are crucial for optimizing EHPVO care, especially in resource-limited settings.