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Gastric antral vascular ectasia successfully treated by endoscopic electrocoagulation
M Yamada1, D Nishimura, H Hoshino
1Department of Internal Medicine, Koseiren Kamo Hospital, Toyota, Japan.
Insights
Endoscopic electrocoagulation effectively treated gastric antral vascular ectasia (GAVE) in cirrhotic patients. This safe, non-invasive method resolved chronic bleeding and anemia, offering a vital alternative to risky surgery.
Area of Science:
- Gastroenterology
- Hepatology
- Endoscopic interventions
Background:
- Chronic blood loss from gastric antral vascular ectasia (GAVE) is a significant clinical challenge, particularly in patients with liver cirrhosis.
- Cirrhotic patients often require frequent blood transfusions due to persistent anemia caused by GAVE.
Observation:
- Two cirrhotic patients (alcoholic and hepatitis C-associated) presented with severe anemia and chronic bleeding from GAVE.
- Endoscopic examination revealed characteristic diffuse erythemas and ectatic capillaries in the gastric antrum.
Findings:
- Endoscopic electrocoagulation using a monopolar probe successfully controlled bleeding from GAVE in both patients.
- Multiple treatment sessions led to eradication of vascular lesions, resolution of anemia, and negative fecal occult blood tests.
Implications:
- Endoscopic electrocoagulation is a safe, non-invasive, and effective treatment for GAVE-related bleeding in cirrhotic patients.
- This endoscopic approach minimizes risks associated with surgical interventions in patients with compromised liver function.
Abstract:
We report two cirrhotic patients with gastric antral vascular ectasia (GAVE) in whom chronic blood loss presented a major problem. Case 1, a 69-year-old man, had alcoholic liver cirrhosis, and case 2, a 75-year-old woman, had liver cirrhosis associated with hepatitis C virus. The patients required repeated blood transfusions but still exhibited persistent anemia. On upper gastrointestinal endoscopy, both patients showed esophageal varices without stigmata of bleeding or red color signs and presented with a characteristic antral appearance so distinctive as to be diagnostic; diffuse erythemas consisting of ectatic and tortuous capillaries throughout the antrum. Endoscopic electrocoagulation treatment with a monopolar probe was effective for controlling blood loss from GAVE. The patients tolerated the procedure well and there were no resultant complications. Several sessions of the treatment resulted in eradication of almost all the vascular lesions, negative fecal occult blood test results, and marked alleviation of their anemia without further treatment. Endoscopic electrocoagulation is suggested to be a safe, non-invasive, and effective treatment for blood loss from GAVE, especially in patients with liver cirrhosis in whom surgery carries an increased risk.