Development of hyperplastic polyps following argon plasma coagulation of gastric antral vascular ectasia

Abstract

The etiology of gastric antral vascular ectasia (GAVE) syndrome or gastric hyperplastic polyps (HPs) is not fully understood. We report a case of gastric HP arising in a patient treated with argon plasma coagulation (APC) for GAVE syndrome. Despite unclear etiologic progression, this and previously reported cases suggest a temporal relationship between the treatment of GAVE and HP. A 68-year-old male with a history of coronary artery disease, congestive heart failure and diabetes type II who initially presented with symptomatic anemia 2 weeks after starting aspirin and clopidogrel therapy. Diagnostic esophagogastroduodenoscopy (EGD) demonstrated diffuse GAVE. He was treated with 5 APC treatments, at 6-week intervals, over a 30 weeks period. 16 months after the initial APC treatment, an EGD performed secondary to persistent anemia demonstrated innumerable, large, bleeding polyps in the gastric antrum. Biopsy performed at that time confirmed hyperplastic gastric polyps. It has been proposed that HPs are regenerative lesions that arise at sites of severe mucosal injury. Our patient's treatment of GAVE with APC created significant mucosal injury, resulting in HP. Technique and genetic factors may have promoted hyperplastic changes during the regeneration of mucosa, at sites previously treated with APC. This case highlights the potential progression of GAVE to HP in a patient with persistent anemia after APC therapy.

Randomized controlled study of endoscopic band ligation and argon plasma coagulation in the treatment of gastric antral and fundal vascular ectasia

“…EBL is proposed as an alternative for APC in the treatment of GAVE that is causing recurrent gastrointestinal (GI) bleeding 10 or is complicated with post-APC polyp formation. 12 EBL was first reported in 2006 as a treatment for refractory GAVE in patients whom failed other treatment modalities, such as APC or hormonal therapy, by Sinha et al 14 Wells et al 10 performed an observational comparative study in 2008 that included nine patients treated with EBL and 13 patients treated with endoscopic thermal therapy (ETT). Their initial experience shows the superiority of EBL over ETT, as regards to reduction of treatment sessions, control of bleeding, period of hospitalization, need for transfusion and increase in hemoglobin values.…”

“…11 EBL was recently found to be useful as a treatment for GAVE 12 and a good alternative for APC, 10 especially in refractory cases 11 and in cases complicated with polyp formation. 12 This prospective, randomized controlled study aimed at comparing the safety and efficacy of EBL and APC in the treatment of GAVE, and of gastric fundal vascular ectasia (GFVE).…”

“…12 This prospective, randomized controlled study aimed at comparing the safety and efficacy of EBL and APC in the treatment of GAVE, and of gastric fundal vascular ectasia (GFVE).…”

Endoscopic treatment of gastric antral vascular ectasia in real‐life settings: Argon plasma coagulation or endoscopic band ligation?

“…GAVE is characterized by mucosal and submucosal vascular ectasias presenting endoscopically as red, spot‐like lesions arranged in linear strips converging at the pylorus or appear diffusely, located predominantly in the gastric antrum. Two morphological types of GAVE have been reported, that is, the linear type which is more commonly seen in patients without cirrhosis, with a female predominance and at an older age than the diffuse type, which tends to occur in patients with cirrhosis, with a male predominance 2‐6 …”

Successful hemostasis and resection of a bleeding gastric polyp by endoscopic banding ligation in a uremic patient taking antiplatelet agent

“…Polyp or tumor bleeding is an uncommon cause of upper gastrointestinal hemorrhage (Van Leerdam 2008 ; Suo et al 2011 ; Lakhwani et al 2000 ). The modalities to treat bleeding polyps or tumors include electrocautery snare polypectomy, adrenaline injection, clipping, argon plasma coagulation and surgery (Hirasaki et al 2009 ; Al-Haddad et al 2007 ; Malik et al 2011 ; Euanorasetr and Sornmayura 2010 ; Shah et al 2015 ). Although electrocautery snare polypectomy is a common method to treat non-bleeding gastrointestinal polyps, hemorrhage is a serious and most common complication of electrocautery snare polypectomy with an incidence ranging from 1.0 to 7.2 % in prospective studies (Lanza et al 1981 ; Muehldorfer et al 2002 ; Chin-Lin Perng et al 2001 ; Ji et al 2014 ).…”