ABSTRACT
Gastric antral vascular ectasia is an unusual cause of upper gastrointestinal bleeding. The most frequent clinical presentation is iron deficiency anemia in a female patient older than 60 years. A third of patients have liver cirrhosis or a connective tissue disease, especially those related to Raynauds syndrome and scleroderma. The severity of this condition is variable, in some cases iron supplements are enough, while in other transfusion requirements are permanent. Currently the therapies most frequently reported in literature are argon plasma coagulation, radiofrequency ablation and endoscopic band ligation of antral mucosa. This article aims to review the available evidence for the management of this condition.
La ectasia vascular gástrica antral es una causa infrecuente de hemorragia digestiva alta cuya forma de presentación más habitual es la anemia ferropriva en una mujer mayor de 60 años. Un tercio de los pacientes tiene antecedente de cirrosis hepática o enfermedades del tejido conectivo relacionadas al síndrome de Raynaud o esclerodermia. El compromiso es de intensidad variable, sin embargo, en casos graves los pacientes pueden requerir transfusiones en forma permanente. En la actualidad las terapias más frecuentemente reportadas en la literatura son la termocoagulación con argón plasma, la ablación con radiofrecuencia y la ligadura de mucosa antral con bandas elásticas. El objetivo principal de este artículo es revisar la evidencia disponible para el manejo de esta condición.
Subject(s)
Humans , Argon Plasma Coagulation , Gastric Antral Vascular Ectasia/therapy , Ligation , Radio Waves/therapeutic useABSTRACT
Estômago em melancia ou ectasia vascular gástrica é rara causa de hemorragia gastrointestinal alta e anemia ferropriva, sendo responsável por 1,2% a 8% das hemorragias digestivas. Relatamos o caso de uma paciente do sexo feminino, idosa, que apresentava anemia ferropriva crônica, com frequentes hemotransfusões, sendo diagnosticada ectasia vascular antral e realizado tratamento endoscópico com eletrocoagulação com argônio. Foi realizada uma eletrocoagulação com argônio, havendo regressão endoscópica das lesões e resolução da anemia da paciente.
Watermelon stomach or gastric vascular ectasia is a rare cause of upper gastrointestinal hemorrhage and iron deficiency anemia account for 1.2-8% of all gastrointestinal bleeding. We report a case of elderly female patient with cronic iron deficiency anemia requiring frequents hemotransfusions. We diagnostic gastric vascular ectasia and realized endoscopic treatment with argon plasma coagulation with regression of injuries and anemia resolution.
Subject(s)
Humans , Female , Aged , Gastric Antral Vascular Ectasia , Anemia , Anemia, Iron-Deficiency , Diagnosis , Gastrointestinal HemorrhageABSTRACT
Introdução e objetivos: A eletrocoagulação com argônio (APC) é um método térmico de não-contato que pode ser utilizado como alternativa ao laser em endoscopia. Um amplo espectro de indicações têm sido propostas para tratamento através de APC, desde a introdução do uso em endoscopia, em 1991. O objetivo deste estudo é avaliar a eficácia do uso do APC na hemostasia endoscópica de lesões sangrantes do esôfago, estômago, duodeno, cólon e reto. Metodologia: Um total de 22 pacientes consecutivos (14M/8F, média de idade 66,7 anos) foram submetidos ao tratamento com APC entre 1998 e fevereiro de 2002. As causas de sangramento incluíam retite actínica (12 pacientes), ectasia vascular do antro gástrico (GAVE) watermelon stomach (6 pacientes), angiodisplasias de esôfago, estômago e cólon (2 pacientes), gastrite actínica (1 paciente) e síndrome de Osler-Weber-Rendu (1 paciente). Resultados: Um total de 49 sessões foram realizadas (média de 2,2 sessões por paciente). Sucesso no tratamento endoscópico foi obtido em 18 pacientes (85,8%). Complicações foram observadas em 3 pacientes: 2 apresentaram dor local após as sessões de APC e um paciente desenvolveu estenose retal tratada com sucesso em uma sessão de dilatação endoscópica. Não houve mortalidade relacionada ao método. Conclusões: APC é um método seguro, efetivo, de relativo baixo custo e boa aceitação pelos pacientes para o tratamento de lesões sangrantes do trato gastrointestinal. Deve, portanto, ser considerado método de primeira escolha no tratamento dessas afecções (AU)
Background and aims: Argon plasma coagulation (APC) is an innovative non-touch electrocoagulation technique. A broad spectrum of indications has been proposed for APC since its introduction into endoscopy in 1991. The aim of this study is to evaluate the efficacy of utilizing APC in the endoscopic hemostasis of bleeding lesions of the esophagus, stomach, duodenun, colon and rectum. Methodology: A total of 22 consecutive patients (14M/ 8 F, mean age 66.7 years) underwent APC treatment between 1998 and february 2002. Causes of bleeding included radiation colitis (12 patients), gastric antral vascular ectasia watermelon stomach (6 patients), esophagus,stomach and colon angiodysplasia (2 patients), radiation gastritis (1 patient) and Osler-Weber-Rendu Syndrome (1 patient). Results: A total of 49 sessions were performed (mean 2.2 sessions / patient). Succesful endoscopic APC treatment was achieved in 18 patients (85,8%). Complications were observed in 2 patients that referred local pain after therapy and 1 patient that developed a rectal stenosis succesfully reversed in one session of endoscopic dilation. No mortality related to APC was observed. Conclusions: APC is a safe, effective, and relative low-cost hemostatic modality for bleeding vascular lesions of the gastrointestinal tract. Therefore, APC should be considered as a first-line therapy for these conditions (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Argon Plasma Coagulation/statistics & numerical data , Gastrointestinal Hemorrhage/surgery , Proctitis/surgery , Telangiectasia, Hereditary Hemorrhagic/surgery , Retrospective Studies , Endoscopy, Gastrointestinal/statistics & numerical data , Treatment Outcome , Angiodysplasia/surgery , Gastric Antral Vascular Ectasia/surgery , Gastritis/surgeryABSTRACT
Gastric antral vascular ectasia (watermelon stomach) is a rare cause of chronic gastrointestinal bleeding, characterized endoscopically by a distinctive appearance of prominent red vascular folds traversing the gastric antrum and radiating to the pyloric sphincter; this appearance has been likened to the dark stripes on the surface of a watermelon. The etiology is unknown, and the usual presentations are iron-deficiency anemia and melena due to chronic gastric blood loss. Diagnosis is made by the characteristic endoscopic appearance and histologic findings. The treatment of choice is not known yet; surgical resection is curative method, but results from endoscopic treatment with heat probes or lasers are promising. We experienced a case of gastric antral vascular ectasia presenting with epigastric pain and melena in a 34-year-old female. The patient was treated with hemigastrectomy and Billroth II anastomosis.
Subject(s)
Adult , Female , Humans , Anemia, Iron-Deficiency , Citrullus , Diagnosis , Gastric Antral Vascular Ectasia , Gastroenterostomy , Hemorrhage , Hot Temperature , Melena , Pyloric Antrum , PylorusABSTRACT
Watermelon stomach or gastric antral vascular ectasia is a rare disorder causing gastric blood loss and iron deficicncy anemia. Endoscopically, it has characteristic thickened red vascular folds radiating from the pylorus to the antrum. This condition is often mis- diagnosed as antral hemorrhagic gastritis. Diagnosis is made primarily by endoscopy. Histologic examination of the endoscopic mucosal biopsies may confirm the endoscopic diagnosis. Treatment for watermelon stomach includes steroids, estrogen-progesterone combinations, somatostatin antagonists, tranexamic acid, heater probe, and laser therapy. Herein we report a case of watermelon stomach presenting with general weakness and persistent iron deficiency anemia for about 2 years in a 70-year-old woman.