Laser ablation of upper gastrointestinal vascular ectasias: long term results.

Sargeant, IR; Loizou, L A; Rampton, David; Tulloch, M; Bown, Stephen G.

doi:10.1136/gut.34.4.470

Cited by 97 publications

(53 citation statements)

References 16 publications

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“…All series have confirmed the efficacy of this endoscopic thermal therapy by reducing or abolishing the need of blood transfusions in about 50% to 80% of cases, with a mean of 3 treatment sessions (range 1-10) [50][51][52][53] . The most serious complication described after laser therapy, even if rare, is represented by gastric perforation.…”

Section: Endoscopic Treatmentmentioning

confidence: 78%

“…However, Bernstein and co-workers presented a case-report of a multifocal gastric cancer developed after repeated sessions of laser therapy over a five-year period [57] . Other important disadvantages of laser endoscopic therapy are the high cost and the need of a long training period, since most severe complications, such as perforation and death, happen more frequently when the endoscopist is not sufficiently skilled with the procedure [51,54] . Argon plasma coagulation (APC) is a noncontact technique with a controllable depth of coagulation (0.5-3 mm).…”

Section: Endoscopic Treatmentmentioning

confidence: 99%

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Diagnosis and management of gastric antral vascular ectasia

Fuccio¹

2013

WJGE

128

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Gastric antral vascular ectasia (GAVE) is an uncommon but often severe cause of upper gastrointestinal (GI) bleeding, responsible of about 4% of non-variceal upper GI haemorrhage. The diagnosis is mainly based on endoscopic pattern and, for uncertain cases, on histology. GAVE is characterized by a pathognomonic endoscopic pattern, mainly represented by red spots either organized in stripes radially departing from pylorus, defined as watermelon stomach, or arranged in a diffused-way, the so called honeycomb stomach. The histological pattern, although not pathognomonic, is characterized by four alterations: vascular ectasia of mucosal capillaries, focal thrombosis, spindle cell proliferation and fibrohyalinosis, which consist of homogeneous substance around the ectatic capillaries of the lamina propria. The main differential diagnosis is with Portal Hypertensive Gastropathy, that can frequently co-exists, since about 30% of patients with GAVE co-present a liver cirrhosis. Autoimmune disorders, mainly represented by Reynaud's phenomenon and sclerodactyly, are co-present in about 60% of patients with GAVE; other autoimmune and connective tissue disorders are occasionally reported such as Sjogren's syndrome, systemic lupus erythematosus, primary biliary cirrhosis and systemic sclerosis. In the remaining cases, GAVE syndrome has been described in patients with chronic renal failure, bone marrow transplantation and cardiac diseases. The pathogenesis of GAVE is still obscure and many hypotheses have been proposed such as mechanical stress, humoural and autoimmune factors and hemodynamic alterations. In the last two decades, many therapeutic options have been proposed including surgical, endoscopic and medical choices. Medical therapy has not clearly shown satisfactory results and surgery should only be considered for refractory severe cases, since this approach has significant mortality and morbidity risks, especially in the setting of portal hypertension and liver cirrhosis. Endoscopic therapy, particularly treatment with Argon Plasma Coagulation, has shown to be as effective and also safer than surgery, and should be considered the first-line treatment for patients with GAVE-related bleeding.

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Section: Endoscopic Treatmentmentioning

confidence: 78%

Section: Endoscopic Treatmentmentioning

confidence: 99%

Diagnosis and management of gastric antral vascular ectasia

Fuccio¹

2013

WJGE

128

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“…As mentioned above, one patient did suffer a contained perforation, but given his two prior left gastric artery embolizations, the presence of gastric necrosis, and the location of the perforation, it is likely that his prior arterial embolizations were causal. However, since there is a previous report of gastric perforation from laser therapy, 16 which occurred primarily with the authors' initial use of the laser and was thought to be due to an excessively high-power setting, we are not able to definitively determine whether the laser therapy also contributed to this adverse outcome.…”

Section: Discussionmentioning

confidence: 69%

“…5,[13][14][15][16][17] In this series, we report six patients who were successfully treated, as evidenced by a decline in the number of packed red blood cells transfused, stabilization of the hematocrit, and lack of clinical signs of gastrointestinal bleeding, even when other therapies directed at GAVE failed to stop the bleeding. One patient required a gastrectomy because of ischemic gastric necrosis from angiographic transarterial embolization.…”

Section: Discussionmentioning

confidence: 97%

Efficacy of neodymium:YAG laser therapy for gastric antral vascular ectasia (GAVE) following hematopoietic cell transplant

Selinger

McDonald

Hockenbery

et al. 2005

Bone Marrow Transplant

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We determined the incidence of severe bleeding from gastric antral vascular ectasia (GAVE) after myeloablative hematopoietic cell transplant and the outcomes after treatment with endoscopic neodymium:YAG laser photocoagulation. From 1992 to 2005, the incidence of severe bleeding from GAVE was 6/4491 (0.13%). All patients had received oral busulfan and four had sinusoidal obstruction syndrome. Gastrointestinal bleeding began a median of 53 days after transplant (range 15-2952). After GAVE was diagnosed by endoscopic and histologic findings, a median of three (range 2-7) sessions of laser therapy were required to control the bleeding with a median of 2737 J (range 1117-6160 J) per session. A median of 16 units (range 4-44) had been transfused prior to laser therapy and a median of four additional units (range 0-113) were transfused until bleeding was controlled. All patients were followed for at least 70 days after the last laser therapy session, with no further episodes of bleeding. Complications were mild and included abdominal pain and asymptomatic ulceration; however, one patient required gastrectomy due to gastric necrosis following transarterial embolizations. In summary, severe bleeding from GAVE is rare following hematopoietic cell transplant. Treatment with endoscopic therapy using the Nd:YAG laser is safe and effective.

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“…Clinical trials of endoscopic treatment in these patients have shown decreased transfusion requirements and increasing hemoglobin values. These did not reach statistically significant levels in some studies due to the small numbers of patients treated [32,[36][37][38][39][40][41].…”

Section: Gastrointestinal Involvementmentioning

confidence: 99%

Gastrointestinal and Hepatic Manifestations of Hereditary Hemorrhagic Telangiectasia

Sharma

Howden

1998

Dig Dis

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Hereditary hemorrhagic telangiectasia (HHT) or Osler-Rendu-Weber (ORW) disease is an autosomal-dominant disorder that frequently presents with gastrointestinal bleeding which may be a diagnostic and therapeutic challenge. Hepatic involvement in this disease is increasingly recognized and poses another therapeutic challenge. With advances in genetic screening and diagnostic procedures, and the increasing awareness of the condition by physicians and patients, this disease is being diagnosed more often. This article reviews the available literature on gastrointestinal and hepatic manifestations of HHT, and the various diagnostic and therapeutic modalities available for its management.

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Laser ablation of upper gastrointestinal vascular ectasias: long term results.

Abstract: Forty one patients with bleeding vascular ectasias of the upper gastrointestinal tract who required blood transfusion were treated with endoscopic Nd:YAG laser photocoagulation and followed for 34 months (median). Four distinct groups of patients were identified.

Cited by 97 publications

References 16 publications

Diagnosis and management of gastric antral vascular ectasia

Diagnosis and management of gastric antral vascular ectasia

Efficacy of neodymium:YAG laser therapy for gastric antral vascular ectasia (GAVE) following hematopoietic cell transplant

Gastrointestinal and Hepatic Manifestations of Hereditary Hemorrhagic Telangiectasia

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