Endoscopic laser treatment of diffuse gastric antral vascular ectasia.

Abstract

Eight patients (six women and two men) were found to have iron deficiency anaemia due to diffuse gastric antral vascular ectasia. The mean age of the patients was 74-6 years (range 57-83). AU required repeated blood transfusions (mean 18 units/year) before treatment. Five patients were classified as having the 'watermelon stomach' (group A) and three the 'honeycomb stomach' (group B), according to criteria described in previous reports. All were treated using neodymium:YAG laser photocoagulation. Significant endoscopic improvement and reduction in blood requirements were noticed in group A in which only one patient required a transfusion after treatment. Results in group B were disappointing. One patient was operated on and the other two still require blood transfusions. Laser treatment was safe in both groups and no major complications were encountered. (Gut 1994; 35: 461-463) The condition is often misdiagnosed as antral haemorrhagic gastritis.35' Biopsies confirm the correct diagnosis with the characteristic features of hyperplastic surface mucosa with dilated and thrombosed capillaries and fibromuscular hyperplasia of the lamina propria with ectatic submucosal venous channels.Although antrectomy offers definitive treatment of the condition, it carries significant short and longterm morbidity and an operative mortality of 5-10%.78 Conservative treatment with blood transfusion, iron replacement, histamine H2 receptor antagonists, sucralfate, steroids, tranexamic acid have all be applied with limited success, in an attempt to balance the blood loss, or to diminish the severity of the bleeding episodes.238 Endostasis has also been used with varying results."-'4 In this report we describe eight patients with DGAVE, treated with the Nd:YAG laser focusing on the different therapeutic response of these patients according to their endoscopic pattern.

Cure of gastric antral vascular ectasia by liver transplantation despite persistent portal hypertension: A clue for pathogenesis

“…9,10 The present study confirms that when GAVE induces recurrent bleeding in cirrhotic patients with liver failure, liver transplantation can cure both problems.…”

Medical and Endoscopic Therapies for Angiodysplasia and Gastric Antral Vascular Ectasia: A Systematic Review

“…[58][59][60][61][62][63][64][65][66][67] There were 10 case series on Nd:YAG therapy (n ¼ 185) that found 20% of patients (0%-51%) had complications, 1.6% (0%-14%) had perforations, 6% (0%-13%) failed therapy, and there was 28% (9%-63%) overall mortality, and 10% (0%-25%) of mortality was therapy or bleeding related. [68][69][70][71][72][73][74][75] A single case series on heater probe (n ¼ 12) found 33% of patients had complications, but there were no perforations, therapy failures, or mortality (0%). 76 A single case series on monopolar coagulation (n ¼ 6) found 33% of patients had complications, no perforations or therapy failures (0%), and mortality data were not reported.…”

Laparoscopic Surgical Treatment for Refractory Gastric Antral Vascular Ectasia

“…Surgical approaches for described in GAVE literature include total gastrectomy with esphagojejunostomy; subtotal gastrectomy, partial gastrectomy and antrectomy with Billroth I, II, and Roux-en Y reconstructions; antrectomy with vagotomy, and laparoscopic antrectomy. 2,4,26,28 Antrectomy seems to be the most commonly performed procedure, representing 40 out of 45 surgically treated GAVE cases in 1 review. 2 Resolution of severe anemia with endoscopic mucosa resection was recently been documented in a single case report.…”

“…Surgical resection is regarded as the only definitive cure, but is typically performed after endoscopic failure, as significant postoperative morbidity and mortality have been reported in past literature. 14,23,24,26,27 Advances in modern surgery have recently lead to reconsiderations of the role of surgical therapy with some authors advocating earlier surgical intervention for refractory GAVE. 2,28 The case described here supports current literature demonstrating clinical resolution of noncirrhotic GAVE after laparoscopic antrectomy.…”