Ismail Qarch, Nawal Lagdali, Fatima Zahra Chabib, Selma Sabbah, Mohamed Borahma, Fatima Zohra Ajana, Meryem Kadiri
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 10
Date of Publication: 2026/10/29
Background and Aims: Porto-sinusoidal vascular disease (PSVD) is a cause of non-cirrhotic portal hypertension frequently complicated by variceal bleeding. In the absence of disease-specific evidence, management strategies are largely extrapolated from cirrhosis, although their applicability to PSVD remains uncertain. This study aimed to evaluate real-world therapeutic strategies and identify factors guiding treatment decisions and bleeding risk in PSVD.
Methods: We conducted a retrospective single-center study including patients with PSVD followed between January 2018 and December 2025. Patients with less than two years of follow-up or incomplete data were excluded. Clinical, endoscopic, and therapeutic variables were analyzed, with a focus on non-selective beta-blockers (NSBB), endoscopic band ligation (EBL), and hemorrhagic decompensation. Univariate and multivariate analyses were performed to identify predictors of bleeding and determinants of combined therapy.
Results: A total of 42 patients were included (mean age 38.8 ± 14.4 years, 73.8% female). Portal hypertension was nearly universal, with esophageal varices in 90.5%, gastric varices in 31.0%, and portal hypertensive gastropathy in 35.7%. Prothrombotic conditions predominated, and splanchnic thrombosis was present in 61.9% of patients.
NSBB therapy could not be initiated in 23.8% of patients. EBL was performed in 66.7%, mainly for secondary prophylaxis or NSBB intolerance. Patients receiving combined NSBB+EBL therapy exhibited a more severe phenotype, with higher rates of esophageal varices (100% vs 69.2%, p = 0.007) and hemorrhagic decompensation (60.7% vs 14.3%, p = 0.007).
Gastric varices (p = 0.008) and portal hypertensive gastropathy (p = 0.047) were significantly associated with bleeding. Prothrombotic etiology was not associated with hemorrhagic risk (p = 1.000). Multivariate analysis did not identify independent predictors of EBL requirement.
Conclusions: In PSVD, management of variceal bleeding appears to be driven by the severity of portal hypertension and endoscopic phenotype rather than by the underlying prothrombotic condition. These findings support a phenotype-driven approach and highlight the limitations of extrapolating cirrhosis-based strategies to this heterogeneous disease.
Porto-sinusoidal vascular disease, Non-cirrhotic portal hypertension, Esophageal varices, Non-selective beta-blockers, Endoscopic band ligation, Hemorrhagic decompensation, Portal hypertension, Antico
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