Dear Juan Carlos,
Thank you for sharing this interesting case with us. I cannot remember a similar case in Vienna… Does splenomegaly and/or thrombocytopenia suggest (prehepatic/presinusoidal) portal hypertension? EUS-guided portal vein pressure measurement might be an option to directly measure portal pressure. Any family history of GI-bleeding in this patients’ family? Are there other (muco)cutaneous signs of vascular malformations in this patient?
In terms of management and treatment i do not have a good idea at the moment.
All the best and i wish you and all the VALDIG team a great meeting in Ascona, which i am unfortunately not able to attend!
Best wishes,
Thomas