Treatment of Esophageal Varices with Bleeding in Non-Cirrhotic Portal Hypertension with Large Splenomegaly

This protocol addresses esophageal variceal bleeding in the setting of non-cirrhotic portal hypertension (NCPH) — a distinct clinical presentation where cirrhosis is absent.

The defining features of this sub-population are the absence of ascites, jaundice, and hepatic encephalopathy, combined with the presence of large splenomegaly. These findings are the key clinical clues that differentiate NCPH from cirrhotic portal hypertension.

The presence of large splenomegaly — alongside the absence of the typical stigmata of cirrhosis — is central to identifying this patient group and shapes the management approach for variceal hemorrhage.

When bleeding cannot be controlled or early re-bleeding occurs, rescue therapy is indicated. This involves portal decompressive interventions — the specific options, preferred sequencing, and patient-selection criteria are detailed in the full protocol.