Treatment of a patient with watermelon stomach using transendoscopic laser photocoagulation

Frager, Joseph D.; Brandt, Lawrence J.; Frank, Michael S.; Morecki, Rachel

doi:10.1016/s0016-5107(88)71280-8

Cited by 22 publications

(4 citation statements)

References 4 publications

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“…No recurrence was encountered during a 7 to 44 month follow up period and this is in accordance with other reports." 9 In a large study with 13 patients, however, complete obliteration of the vascular lesion was not seen. "…”

Section: Discussionmentioning

confidence: 96%

Endoscopic laser treatment of diffuse gastric antral vascular ectasia.

Potamiano

Carter

Anderson

1994

Gut

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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.

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Section: Discussionmentioning

confidence: 96%

Endoscopic laser treatment of diffuse gastric antral vascular ectasia.

Potamiano

Carter

Anderson

1994

Gut

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“…Several studies of laser photocoagulation followed an early case report from Frager et al [46]. Gostout et al [11] showed endoscopic and haematological (elimination of transfusion need) improvements in 12 of 13 previously transfusion-dependent GAVE patients.…”

Section: Therapymentioning

confidence: 99%

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

2008

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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.

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“…A non-contact method of tissue coagulation would therefore seem preferable to the heater probe. Initially reported by Frager and colleagues and supported by a series from Gostout, the Nd:YAG laser has also been shown to be effective in eliminating the transfusion requirement in this population of patients [10,11]. Both methods of therapy required an average of four treatment sessions.…”

Section: Discussionmentioning

confidence: 96%

Endoscopic laser therapy of the watermelon stomach

Bjorkman

Buchi

1992

Lasers Surg Med

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Endoscopic laser therapy has been used in the treatment of vascular lesions throughout the gastrointestinal tract. The "watermelon stomach" is a pattern of vascular ectasia in the gastric antrum that results in chronic gastrointestinal blood loss and iron deficiency anemia. We have treated 7 transfusion dependent patients with a watermelon stomach using endoscopic laser therapy. Four of these patients were treated with the argon laser and 3 with the Nd:YAG laser. Patient age and prior transfusion requirements were similar in both groups. The mean number of treatments to obliterate vascular lesions and eliminate the need for transfusions was 5.75 +/- 0.89 (SEM) for the argon laser and 2.33 +/- 0.27 for the Nd:YAG laser (P < 0.05). Lesions recurred and required retreatment in 1 patient treated with the Nd:YAG laser and 3 patients treated with the argon laser (mean follow-up of 35 months). We conclude that endoscopic laser therapy with either the argon or Nd:YAG laser is an effective treatment modality for antral vascular ectasia (watermelon stomach). The Nd:YAG laser requires fewer treatment sessions than the argon laser to obliterate the lesions without increased risk of complications.

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Treatment of a patient with watermelon stomach using transendoscopic laser photocoagulation

Cited by 22 publications

References 4 publications

Endoscopic laser treatment of diffuse gastric antral vascular ectasia.

Endoscopic laser treatment of diffuse gastric antral vascular ectasia.

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

Endoscopic laser therapy of the watermelon stomach

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