The Biopsy GAVE the Diagnosis

Gastrointestinal polypoid lesions: a poorly known endoscopic feature of portal hypertension

“…These lesions may be associated with clinically significant bleeding in otherwise well‐compensated cirrhosis (28% of patients). To our knowledge, such a cohort, with polypoid lesions associated with portal hypertension, has not been previously reported in the upper GI tract of cirrhotic patients, except for few case reports: one reported red bump lesions in the ileum; 1 another reported an isolated duodenal polyp; 9 two reported the histological description of hyperplastic gastric polyps; 10, 11 and three described nodular gastric antral vascular ectasia lesions 12 . For the colon, some authors have already reported polypoid lesions due to portal hypertensive colopathy 13 .…”

“…To our knowledge, such a cohort, with polypoid lesions associated with portal hypertension, has not been previously reported in the upper GI tract of cirrhotic patients, except for few case reports: one reported red bump lesions in the ileum; 1 another reported an isolated duodenal polyp; 9 two reported the histological description of hyperplastic gastric polyps; 10,11 and three described nodular gastric antral vascular ectasia lesions. 12 For the colon, some authors have already reported polypoid lesions due to portal hypertensive colopathy. 13 Eventually, we showed that adequate control of portal hypertension was able to stop bleeding from these lesions and that either systemic or local treatment was associated with a reduction in size or long-term disappearance of these lesions Three questions arise from this series.…”

Radiofrequency ablation therapy – the grave for GAVE (gastric antral vascular ectasia)?

“…Ectatic extension into deeper mucosa along with partial gastric rugal involvement and concomitant hypercontractility of the antrum might explain treatment failure and persistence of the lesions 10 . The endoscopic appearance has been classified as traditional watermelon type, diffuse or honeycomb variant, and recently proposed is a third variant with a nodular component but sharing the same histological characteristics 11 . It is not clear whether the unique microvascular architectural aspects of each type will play a role in the response to therapy, though it has been suggested that RFA may be advantageous in the diffuse and nodular type owing to larger surface area and depth of ablation provided.…”

Gastric Polyposis: A Rare Cause of Iron Deficiency Anemia in a Patient With Portal Hypertension

“…Endoscopic appearance alone cannot distinguish between hyperplastic gastric polyps, gastric polyps secondary to portal hypertension, and the nodular subtype of GAVE. 9 The presence of histologic features such as prominent capillary ectasia in an edematous lamina propria without of histologic features suggestive of nodular GAVE suggests that these polyps are a distinct entity. The presence of a smooth muscle layer in many of these vessels also suggests that the formation of gastric polyps was a direct consequence of the patient's portal hypertension, leading to congestion in the gastric wall.…”