Endoscopic laser therapy of the watermelon stomach

Bjorkman, David J.; Buchi, Kenneth N.

doi:10.1002/lsm.1900120504

Cited by 28 publications

(11 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, 3 patients treated successfully with an argon laser required repeated treatments [47]. In a series of 26 GAVE patients treated with argon plasma coagulation, transfusion requirements were abolished in 77% over a 16-month median follow-up period [48].…”

Section: Therapymentioning

confidence: 99%

Gastric Antral Vascular Ectasia (GAVE): An Update on Clinical Presentation, Pathophysiology and Treatment

2008

View full text Add to dashboard Cite

Gastric antral vascular ectasia (GAVE), though a rare disorder, causes up to 4% of non-variceal upper GI bleeding. This paper gives an overview of studies examining clinical presentation and pathophysiology, and reviews the current evidence for invasive and non-invasive treatments. GAVE is often associated with systemic illnesses, such as cirrhosis of the liver, autoimmune connective tissue disorders, bone marrow transplantation and chronic renal failure. The pathophysiological changes leading to GAVE have not been fully explained and remain controversial. Patient presentation varies from chronic iron-deficiency anaemia to heavy acute gastrointestinal bleeding. It is important to differentiate GAVE from portal hypertensive gastropathy as GAVE does not respond to measures reducing portal pressures. Endoscopic ablation (Nd:YAG-laser or argon plasma coagulation) is the first-line treatment of choice. As evidence for pharmacological therapy with oestrogen (and/or progesterone), tranexamic acid or thalidomide stems from case reports only, these should be used if endoscopic measures have failed to stop chronic blood loss. Surgical antrectomy should be reserved for unresponsive cases as it is associated with a high mortality. Ultimately, treatment of the underlying medical co-morbidities may lead to resolution of GAVE.

show abstract

Section: Therapymentioning

confidence: 99%

Gastric Antral Vascular Ectasia (GAVE): An Update on Clinical Presentation, Pathophysiology and Treatment

2008

View full text Add to dashboard Cite

show abstract

“…The depth of tissue injury is dependent upon the power setting, the duration of the contact and the degree of pressure applied to the targeted area (1 mm in depth for slight pressure of 2 s) Nd:YAG Laser. The hemostatic effect has been shown to be earlier compared with APC and the long-term results are similar [35]. A thermal effect can reach 4-6 mm in depth on the targeted tissue.…”

Section: Discussionmentioning

confidence: 77%

Portal Hypertensive Gastropathy

Cestari¹,

Missale²,

Cengia³

et al. 2009

Frontiers of Gastrointestinal Research

View full text Add to dashboard Cite

Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE), frequently combined, are responsible for acute and chronic bleeding in patients with liver cirrhosis and portal hypertension. Endoscopy is basic for detection of typical features and histological examination can enhance diagnostic accuracy. PHG is frequently responsible for chronic bleeding/anemia and the first treatment option is medical therapy; otherwise, failures can be managed by shunting procedures, such as transjugular intrahepatic portosystemic shunt or surgery. Vasoactive drugs (terlipressin or somatostatin and analogues) can be effectively adopted in less common acute bleeding episodes and additional endoscopic therapy can be performed. Endoscopic hemostatic techniques, like argon plasma coagulation, heater probe and laser, are the first-line treatment for both acute and chronic bleeding from GAVE; preliminary data supported the effectiveness of cryotherapy, radiofrequency and banding ligation as appropriate management options.

show abstract

“…Special points A majority of studies have used sucralfate prophylactically in order to reduce the risk of thermal ulcer formation. One study has indicated that the mean number of treatments needed to obliterate the vascular lesions and eliminate the need for transfusions was less for Nd:YAG laser when compared with APC (2.33 ± 0.27 vs 5.75 ± 0.89) [35]. Cost-effectiveness No data are available.…”

Section: Neodymium:yttrium-aluminum-garnet Laser Therapymentioning

confidence: 97%

Portal hypertensive gastropathy and gastric antral vascular ectasia

Garcia

Sanyal

2001

Curr Treat Options Gastro

View full text Add to dashboard Cite

Portal hypertensive gastropathy (PHG) causes both acute and chronic blood loss from the gastrointestinal tract in patients with portal hypertension. Gastric antral vascular ectasia (GAVE) is a distinct condition also associated with portal hypertension that can cause acute and chronic upper gastrointestinal blood loss. These conditions frequently, but not invariably, are diagnosed by upper endoscopy. Although they are fairly prevalent, only 15% to 20% of subjects experience symptomatic gastrointestinal blood loss. Acute gastrointestinal bleeding from PHG should first be treated with octreotide (100 mg bolus intravenously, followed by a 50 mg/h continuous intravenous infusion). If the bleeding does not stop or slow down appreciably within 24 to 48 hours, propranolol may be administered orally to those patients who are hemodynamically stable. Propranolol should be started at 40 mg/d orally in two divided doses. If the patient can tolerate the propranolol and is still bleeding, the dosage may be titrated up to the maximum tolerated amount. For those subjects who are unable to tolerate beta-blockers or continue to bleed despite beta-blocker therapy, transjugular intrahepatic portosystemic shunt (TIPS) is the next line of treatment. Portal decompressive surgery is reserved for those who are not candidates for TIPS and where the appropriate expertise is available. Prevention of chronic gastrointestinal blood loss from PHG should be attempted with beta-blockers, with the dosage titrated up to achieve a resting heart rate of approximately 60 beats per minute. In patients who do not respond to beta-blockers, a TIPS should be placed. The role of long-acting release octreotide in this setting is experimental. The primary treatment of actively bleeding GAVE as well as recurrent bleeding from GAVE is endoscopic ablation of the lesion using either argon plasma coagulation, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, or heater probe. TIPS and beta-blockers are ineffective for the long-term prevention of recurrent bleeding from GAVE. For selected patients with severe recurrent bleeding or uncontrollable acute bleeding from GAVE, an antrectomy with Billroth I anastomosis may be considered.

show abstract

Endoscopic laser therapy of the watermelon stomach

Cited by 28 publications

References 12 publications

Gastric Antral Vascular Ectasia (GAVE): An Update on Clinical Presentation, Pathophysiology and Treatment

Gastric Antral Vascular Ectasia (GAVE): An Update on Clinical Presentation, Pathophysiology and Treatment

Portal Hypertensive Gastropathy

Portal hypertensive gastropathy and gastric antral vascular ectasia

Contact Info

Product

Resources

About