Diffuse antral vascular ectasia

Lee, Frank I.; Costello, F T; Flanagan, N. G.; Vasudev, K S

doi:10.1016/s0016-5107(84)72326-1

Cited by 70 publications

(47 citation statements)

References 8 publications

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“…In this latter case, it has been reported that GAVE can even represent the presenting syndrome, preceding the development of the autoimmune disorders by several months [21] . About 30% of patients with GAVE co-present a liver cirrhosis [22][23][24] , whatever etiology (viral, autoimmune, toxicmetabolic). In the remaining cases, GAVE syndrome has been described in patients with chronic renal failure [10] , bone marrow transplantation [25] and cardiac diseases [10,26] .…”

Section: Gave and Associated Diseasesmentioning

confidence: 99%

Diagnosis and management of gastric antral vascular ectasia

Fuccio¹

2013

WJGE

122

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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: Gave and Associated Diseasesmentioning

confidence: 99%

Diagnosis and management of gastric antral vascular ectasia

Fuccio¹

2013

WJGE

122

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“…GAVE is located in the gastric antrum and is characterized by a typical endoscopic pattern showing red spots either organized in stripes departing radially from the pylorus, the so-called ‘watermelon stomach’, or randomly distributed, ‘honeycomb stomach’ [3]. GAVE can develop in a widely variable spectrum of diseases [4,5,6,7,8,9], including liver cirrhosis [7,8,9]. …”

Section: Introductionmentioning

confidence: 99%

Endoscopic Argon Plasma Coagulation for the Treatment of Gastric Antral Vascular Ectasia-Related Bleeding in Patients with Liver Cirrhosis

et al. 2009

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Background and Aim: Gastric antral vascular ectasia (GAVE) is a cause of bleeding in patients with liver cirrhosis. Argon plasma coagulation (APC) is the most used endoscopic treatment for GAVE-related bleeding. Treatment failures have been described in patients with haemorrhagic diathesis; post-procedure complications include haemorrhages and septicaemia. The aim of the study was to evaluate efficacy and safety of APC treatment of GAVE-related bleeding in patients with liver cirrhosis. Methods: Patients included were suffering from GAVE-related bleeding and liver cirrhosis. APC treatment was performed until eradication. Resolution of transfusion-dependent anaemia and evaluation of complications were the primary outcomes. Results: 20 patients (16 Child C and 4 Child B) were enrolled and prospectively followed for a mean period of 28 months. GAVE eradication was achieved in all patients after a median of 3 sessions (range 1–10). Resolution of anaemia was achieved in 18 patients. Six patients had relapse of GAVE after a mean of 7.7 months, successfully retreated by APC. Hyperplastic polyps developed in 3 patients causing active bleeding in 2 cases. Five patients had liver transplants and 1 had a relapse of GAVE after transplantation. Conclusion: APC is an effective and safe endoscopic treatment for GAVE in patients with liver cirrhosis.

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“…3,4 GAVE in the setting of hematopoietic cell transplant differs from the more common presentation which is often seen in patients who are elderly, have chronic liver disease, or have connective tissue disease. [5][6][7] GAVE in the post transplant setting is almost always a diffuse process involving the entire antrum, often with extension into the body of the stomach, while GAVE in the nontransplant population usually presents as a typical 'watermelon stomach,' with the classic endoscopic findings of linear erythematous stripes within the antrum which radiate out from the pylorus (Figure 1). 3 We report the incidence of severe bleeding from GAVE after myeloablative hematopoietic cell transplant and the results of endoscopic therapy with the neodymium:YAG (Nd:YAG) laser in these patients.…”

Section: Introductionmentioning

confidence: 99%

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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Diffuse antral vascular ectasia

Cited by 70 publications

References 8 publications

Diagnosis and management of gastric antral vascular ectasia

Diagnosis and management of gastric antral vascular ectasia

Endoscopic Argon Plasma Coagulation for the Treatment of Gastric Antral Vascular Ectasia-Related Bleeding in Patients with Liver Cirrhosis

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

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