Skip to main content

Advertisement

SpringerLink
Log in

Successful treatment of refractory gastric antral vascular ectasia using transcatheter arterial embolization

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

In January 2008, a 67-year-old woman was admitted to our hospital because of hepatitis C virus-related cirrhosis and hepatocellular carcinoma (HCC). In February 2010, she had tarry stools and anemia resulting from gastric antral vascular ectasia (GAVE). Argon plasma coagulation (APC) treatment for GAVE was performed at that time. She revisited our hospital in July 2010 because of tarry stools and anemia caused by GAVE recurrence, which required 5 APC sessions and blood transfusion to control the bleeding. In October 2010, she arrived at our hospital by ambulance because of hemorrhagic shock resulting from GAVE recurrence. Despite performing 5 APC sessions and multiple blood transfusions, the tarry stools and anemia persisted during the hospitalization period. In December 2010 and January 2011, second-stage selective transcatheter arterial embolization (TAE) of the right gastric and right gastroepiploic arteries using microcoils was performed for the treatment of the refractory GAVE. Upper gastrointestinal endoscopy performed after TAE revealed the disappearance of mucosal diffuse spotty redness. In addition, no complications such as gastric ulcer and necrosis were observed. Selective TAE, effectively resolved the GAVE and anemia, and no recurrence has been observed during the last 24 months. Therefore, TAE may be a safe and radical treatment for refractory GAVE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Payen J, Cales P, Voigt J, et al. Severe portal hypertensive gastropathy and antral vascular ectasia are distinct entities in patients with cirrhosis. Gastroenterology. 1995;108:138–44.

    Article  PubMed  CAS  Google Scholar 

  2. Dulai GS, Jensen DM, Kovacs TO, et al. Endoscopic treatment outcomes in watermelon stomach patients with and without portal hypertension. Endoscopy. 2004;36:68–72.

    Article  PubMed  CAS  Google Scholar 

  3. Terawaki H, Kobayashi S, Kato J, et al. A case report of hemodialysis patient who presented recurrent bleeding from gastric antral vascular ectasia (GAVE) associated with liver cirrhosis: the effectiveness of trans-arterial embolization to bilateral gastric arteries. J Jpn Soc Dial Ther. 2008;41:803–8.

    Article  Google Scholar 

  4. Rider JA, Klotz AP, Kirsner JB. Gastritis with veno-capillary ectasia as a source of massive gastric hemorrhage. Gastroenterology. 1953;24:118–23.

    PubMed  CAS  Google Scholar 

  5. Jabbari M, Cherry R, Lough JO, et al. Gastric antral vascular ectasia: the watermelon stomach. Gastroenterology. 1984;87:1165–70.

    PubMed  CAS  Google Scholar 

  6. Lee FL, Costello F, Flanagan N, et al. Diffuse antral vascular ectasia. Gastrointest Endosc. 1984;30:87–90.

    Article  PubMed  CAS  Google Scholar 

  7. Sebastian S, O’Morain CA, Buckley MJ. Review article: current therapeutic options for gastric antral vascular ectasia. Aliment Pharmacol Ther. 2003;18:157–65.

    Article  PubMed  CAS  Google Scholar 

  8. Gostout CJ, Viggiano TR, Ahlquist DA, et al. The clinical and endoscopic spectrum of the watermelon stomach. J Clin Gastroenterol. 1992;15:256–63.

    Article  PubMed  CAS  Google Scholar 

  9. Sato T, Yamazaki K, Akaike J, et al. Endoscopic band ligation for refractory gastric antral vascular ectasia associated with liver cirrhosis. Clin J Gastroenterol. 2011;4:108–11.

    Article  Google Scholar 

  10. Moss SF, Ghosh P, Thomas DM, et al. Gastric antral vascular ectasia: maintenance treatment with estrogen-progesterone. Gut. 1992;33:715–7.

    Article  PubMed  CAS  Google Scholar 

  11. McCormick PA, Ooi H, Crosbie O. Tranexamic acid for severe bleeding gastric antral vascular ectasia in cirrhosis. Gut. 1998;42:750–2.

    Article  PubMed  CAS  Google Scholar 

  12. Peterson A, Varga J. Cyclophosphamide: a novel treatment of gastric antral vascular ectasia associated with systemic sclerosis? Curr Rheumatol Rep. 2010;12:4–7.

    Article  PubMed  Google Scholar 

  13. Sargeant IR, Loizou LA, Rampton D, et al. Laser ablation of upper gastrointestinal vascular ectasias: long term results. Gut. 1993;34:470–5.

    Article  PubMed  CAS  Google Scholar 

  14. Fuccio L, Zagari RM, Serrani M, et al. Endoscopic argon plasma coagulation for the treatment of gastric antral vascular ectasia-related bleeding in patients with liver cirrhosis. Digestion. 2009;79:143–50.

    Article  PubMed  CAS  Google Scholar 

  15. Gross SA, Al-Haddad M, Gill KRS, et al. Endoscopic mucosal ablation for the treatment of gastric antral vascular ectasia with the HALO90 system: a pilot study. Gastrointest Endosc. 2008;67:324–7.

    Article  PubMed  Google Scholar 

  16. Lecleire S, Ben-Soussan E, Antonietti M, et al. Bleeding gastric vascular ectasia treated by argon plasma coagulation: a comparison between patients with and without cirrhosis. Gastrointest Endosc. 2008;67:219–25.

    Article  PubMed  Google Scholar 

  17. Nakamura S, Mitsunaga A, Konishi H, et al. Long-term follow up of gastric vascular ectasia treated by argon plasma coagulation. Dig Endosc. 2006;18:128–33.

    Article  Google Scholar 

  18. Je Y, Schutz FA, Choueiri TK. Risk of bleeding with vascular endothelial growth factor receptor tyrosine-kinase inhibitors sunitinib and sorafenib: a systematic review and meta-analysis of clinical trials. Lancet Oncology. 2009;10:967–74.

    Article  PubMed  CAS  Google Scholar 

  19. Parente F, Petrillo M, Vago F, et al. The watermelon stomach: clinical, endoscopic, endosonographic, and therapeutic aspects in three cases. Endoscopy. 1995;27:203–6.

    Article  PubMed  CAS  Google Scholar 

  20. Robertson I, Tait N, Jackson J. Vascular ectasia of the gastric antrum: angiographic findings. Am J Roentgenol. 1996;166:87–9.

    Article  CAS  Google Scholar 

  21. Ashiya E, Yagi N, Shiomi H, et al. A case report of gastric vascular ectasia patient successfully treated by trans-arterial embolization despite the inefficiency of argon plasma coagulation. Jpn J Gastroenterol. 2003;100:A304.

    Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Sendai Medical Center, 2-8-8 Miyagino, Sendai, Miyagi, 983-8520, Japan

    Haruka Yoshida, Hiroki Takahashi, Hiromichi Akoshima, Kenji Noguchi, Nobukazu Tanabe, Yutaka Mano, Katsuaki Ukai & Keiichi Tadokoro

  2. Chida Medical Clinic, Sendai, Japan

    Nobuyuki Chida

Authors
  1. Haruka Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroki Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiromichi Akoshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nobuyuki Chida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenji Noguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nobukazu Tanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yutaka Mano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Katsuaki Ukai
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Keiichi Tadokoro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Haruka Yoshida.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoshida, H., Takahashi, H., Akoshima, H. et al. Successful treatment of refractory gastric antral vascular ectasia using transcatheter arterial embolization. Clin J Gastroenterol 6, 231–236 (2013). https://doi.org/10.1007/s12328-013-0385-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-013-0385-y

Keywords

Search

Navigation