The significance of gastric and duodenal histological ischemia reported on endoscopic biopsy

Abstract

It is unknown whether pathological reports of ischemia obtained from gastroduodenal biopsy suggests a diagnosis, prognosis or requires additional evaluation. The aim of this study was to review the natural history, clinical presentation, endoscopic appearance, treatments and major clinical outcomes of patients with gastroduodenal ischemia. Case series of fourteen patients with variable etiologies, seven patients with gastric and seven patients with duodenal origin were obtained from a search of our endoscopic pathologic database for reports of histological ischemia. The most common indication for upper endoscopy was upper gastrointestinal bleeding (71%). Half of the endoscopic lesions appeared very severe. There were six cases of rebleeding (43%) and four deaths (29%). CT scanning was frequently used (12 cases, 86%), but was diagnostic in only three cases. Patients with underlying vascular pathology have substantial 6-month mortality (29%).

Gastric ischemia due to critical stenosis of the celiac trunk

“…GI results from diffuse or localized vascular insufficiency caused by different etiologies that may be classified by systemic hypoperfusion (such as shock or sepsis) or splanchnic vessel hypoperfusion secondary to gastric volvulus, acute gastric dilatation, stenosis, thrombosis, embolism, vasculitis or vasoconstriction 3,4 . Other rare causes of GI include endoscopic interventions (endoscopic submucosal dissection, injection sclerotherapy), postoperative conditions (distal pancreatectomy with celiac axis resection, subtotal gastrectomy, highly selective vagotomy, splenectomy, gastric restrictive procedure using staplers, esophageal surgery) and even cocaine abuse 3,4 . The celiac artery is the first major branch of the abdominal aorta and gives some of the stomach blood supply through the left gastric artery and also other organs as the spleen (by the splenic artery branch) and the liver (by the common hepatic artery) 1 .…”

“…Although the collateral blood supply to the stomach is protective, systemic hypotension or occlusion of the main arteries, as the case of our patient, may result in GI 2 . The development of the ischemia leads into main symptoms such as abdominal pain, ulcers, gastrointestinal bleeding, and even perforation [2][3][4][5] . The progression of the vascular occlusion can manifest as either acute or chronic abdominal angina.…”

“…In acute GI, patients can develop nausea, vomiting, upper gastrointestinal bleeding, abdominal distention, and symptoms and signs related to underlying predisposing conditions such as hypoperfusion or shock. In chronic GI, that may present as ischemic gastroparesis, patients usually develop abdominal pain, nausea, vomiting, overt or occult gastrointestinal bleeding, anemia, diarrhoea, and weight loss 3,4 . The diagnosis is based on endoscopic and radiological examination and may be confirmed by anatomophatological study of biopsies.…”

“…2018, Vol. 41, Nº 1, enero-abril introDuction Gastric ischemia (GI) results from diffuse or localized vascular insufficiency caused by different etiologies such as systemic hypotension, vasculitis, disseminated thromboembolism or celiac or mesenteric stenosis [1][2][3][4] . We present a case of gastric ischemia due to critical stenosis of the celiac artery with an endovascular therapy approach.…”

“…CT scan helps in determining the etiology of ischemia in some cases. Findings such as thrombosis, extensive vascular calcifications or tumour progression may guide specific therapeutic modalities in certain clinical scenarios 4 . Endoscopic findings vary on the etiology and chronicity.…”