A 57-year-old man with nonalcoholic steatohepatitis, newly diagnosed hepatocellular
carcinoma, and portal hypertension with acalculous cholecystitis had previously undergone
endoscopic cholecystostomy because he was deemed to be an inoperable candidate for
cholecystectomy. He presented 8 weeks later for removal of the lumen-apposing metal
stent (LAMS) because his symptoms had improved. Endoscopic inspection of the gallbladder
mucosa revealed a mosaic pattern suggestive of portal hypertensive changes of the
gallbladder mucosa. The mucosa appeared erythematous and edematous (A) with a mosaic-like pattern (B) and a scarlatina-like appearance (C) when viewed up close. Although subtle upon initial viewing, when compared with images
of the gallbladder mucosa of a patient without features of portal hypertension (D), the variance in mucosal appearance was conspicuous. Portal hypertensive gastropathy
(PHG) is a well-known phenomenon; however, portal hypertensive cholepathy (also known
as portal hypertension−related change in gallbladder mucosa) as an entity is not well
known. The findings in our patient could be likened to findings of mild PHG, where the gastric
mucosa appears reddened and edematous with a snakeskin pattern. We believe this is
the first reported case of portal hypertensive cholepathy.
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Publication history
Published online: February 09, 2021
Mohamed O. Othman, MD, Associate Editor for Focal PointsIdentification
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© 2021 by the American Society for Gastrointestinal Endoscopy
