Endoscopic laser therapy for watermelon stomach

Gostout, Christopher J.; Ahlquist, David A.; Radford, C.M.; Viggiano, Thomas R.; Bowyer, Brad A.; Balm, Rita K.

doi:10.1016/0016-5085(89)90513-1

Cited by 88 publications

(23 citation statements)

References 17 publications

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“…All series have confirmed the efficacy of this endoscopic thermal therapy by reducing or abolishing the need of blood transfusions in about 50% to 80% of cases, with a mean of 3 treatment sessions (range 1-10) [50][51][52][53] . The most serious complication described after laser therapy, even if rare, is represented by gastric perforation.…”

Section: Endoscopic Treatmentmentioning

confidence: 77%

Diagnosis and management of gastric antral vascular ectasia

Fuccio¹

2013

WJGE

126

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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: Endoscopic Treatmentmentioning

confidence: 77%

Diagnosis and management of gastric antral vascular ectasia

Fuccio¹

2013

WJGE

126

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“…Little data exist on efficacy of endoscopic therapy for PHG bleeding [71,245] . No single predominant site of bleeding is identified that can be locally treated at endoscopy.…”

Section: Sucralfate and Acid-suppressing Medicationsmentioning

confidence: 99%

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

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AIM:To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. METHODS:Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS:PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepaticportosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. SYSTEMA...

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“…17,29 In one study, 13 transfusion-dependent patients were treated with Nd:YAG laser, of whom 12 had remarkable response with elimination of transfusion requirement over a median follow-up of two years. 8,31 Argon plasma coagulation (APC) has been found to be equally effective in the treatment of GAVE and superior in cost, convenience, and complication rates. 29 APC is a noncontact electro-coagulation technique using a jet of ionized argon gas to deliver monopolar current to the target tissues.…”

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confidence: 99%

Gastric Antral Vascular Ectasia: Case Report and Review of the Literature

Kar

Mitra

Resnick

et al. 2012

Clinical Medicine & Research

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Gast ric antral vascular ectasia (GAVE) is a rare cause of upper gastrointestinal (GI) bleeding, accounting for 4% of nonvariceal upper GI bleeding and associated with occult bleeding that manifests as iron deficiency anemia. 1 In recent years, it has emerged as a distinctive, well-defined entity within the spectrum of acquired vasculopathies of the stomach.We report two cases of GAVE presenting with two different endoscopy findings. We discuss the etiology, endoscopic features, histology, pathogenesis, and management options of this rare entity, and present a review of the pertinent literature. Case 1A man, age 57 years, presented with a one-week history of hematemesis. He described three episodes of coffee ground emesis, about a half-cupful on each occasion. The most recent episode occurred on the day of admission. His past medical history was significant for alcoholic cirrhosis with portal hypertension. He had an episode of hematochezia in the past that was diagnosed as a diverticular bleed on colonoscopy. His social history was significant for alcohol abuse, but he had quit drinking about 10 years prior.His vital signs showed a temperature of 98.9 o F, pulse 102 beats/minute, respiratory rate 16 breaths/minute, and blood pressure 120/79 mm Hg. Physical examination revealed a pale, jaundiced, malnourished male with ascites, pedal edema, and bilateral basal crackles. Initial laboratory studies were significant for hemoglobin of 8.8 gm/dL (reference range 12.9-17.3 g/dL). Serum liver tests Gastric antral vascular ectasia is the source of up to 4% of nonvariceal upper gastrointestinal bleeding. It can present with occult bleeding requiring transfusions or with acute gastrointestinal bleeding. It is associated with significant morbidity and mortality and has been associated with such underlying chronic diseases as scleroderma, diabetes mellitus, and hypertension. Approximately 30% of cases are associated with cirrhosis. We report two cases of gastric antral vascular ectasia with two strikingly different endoscopic appearances. We further describe the clinical, endoscopic, histologic, and therapeutic aspects of this entity.

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Endoscopic laser therapy for watermelon stomach

Cited by 88 publications

References 17 publications

Diagnosis and management of gastric antral vascular ectasia

Diagnosis and management of gastric antral vascular ectasia

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gastric Antral Vascular Ectasia: Case Report and Review of the Literature

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