Endoscopic findings of the small intestine in patients with portal hypertension: a literature review

Abstract

Portal hypertension is a systemic hemodynamic syndrome, most commonly associated with liver cirrhosis, characterized by a sustained increase in portal venous pressure and profound alterations in splanchnic circulation. Although its classic gastrointestinal manifestations are well established, involvement of the small intestine has historically been underdiagnosed, largely due to the limitations of conventional endoscopic techniques. The introduction of capsule endoscopy has enabled complete visualization of the jejunal and ileal mucosa, revealing a high prevalence of findings consistent with portal hypertensive enteropathy. The aim of this study was to review the literature from the past ten years regarding endoscopic findings of the small intestine in patients with portal hypertension evaluated by capsule endoscopy, with emphasis on morphological alterations and their clinical and surgical implications. This narrative review was based on searches of the PubMed/MEDLINE, SciELO, and Embase databases, and seven original studies were included. The prevalence of portal hypertensive enteropathy ranged from 40% to over 90%. The main findings consisted of vascular lesions—such as small bowel varices and vascular ectasias—and nonvascular mucosal alterations, including diffuse edema and erythema. Extensive vascular lesions, particularly when associated with concomitant mucosal changes, were correlated with greater severity of liver disease and a higher risk of gastrointestinal bleeding. In conclusion, capsule endoscopy is a fundamental diagnostic tool for the evaluation of the small intestine in portal hypertension, with significant impact on risk stratification and clinical and surgical management.