Gastral antral vascular ectasias – Successful long-term result with complex endoscopic treatment, including band ligation and HPU/APC

Introduction: Gastral antral vascular ectasia (GAVE) is a rare cause of upper GI bleeding, that affects mainly antral mucosa and submucosa, as a small-vessel malformation. The endoscopic manifestation is very special with lenghtwise vascular ectasias leading to pylorus, mimicking stripes of the watermelon, or diffuse antral involvement (DAVE), showing honey-comb feature. In majority of cases it occurs in patients suffering liver cirrhosis or autoimmune disease. It can cause even occult bleeding, leading to chronic anemy, or overt, life-threatening bleeding, as well. Patients: In the last 6 years we diagnosed GAVE/DAVE in 21 pts (9 GAVE/12 DAVE). We had 12 men (age:63.9 (51 – 83 ys)) and 9 women (age 72.4 (61 – 86)). The clinical manifestation was chronic blood loss in 10, acute in 1 patient, 3 pts had even chronic blood loss with acute episode and we had 7 pts without evidence of any kind of former bleeding. In 10 pts we did not perfomed endoscopic treatment (7 without sign of former bleeding, 1 patient had esophageal varices, that were treated by endoscopic ligation, and in 2 others the source of bleeding was obviously portal gastropathy. In 11 pts that were treated by endoscopic methods, we applied endoscopic band ligation (EBL) of antral mucosa exclusively in 4 pts (I.), EBL+ HeatProbe Unit (HPU) in other 4 pts (II.), 1 patient with EBL+argone plasma coagulation (APC) (III.) and 2 pts with only HPU (IV). The average number of sessions were 2.2 (1 – 4). The increase of average hemoglobin level at the end of follow up were 37.5; 16.3; 11 and 19.5 g/l, respectively. The need of transfusion before and after completion of endoscopic treatment until the end of the follow up were 68 vs. 6 Unit; 32 vs. 3 Unit; 34 vs. 8 Unit and 30 vs. 0 Unit, respectively. 7/11 (63.6%) pts did not need any more transfusion, in 4/11 hospital admission were needed because of anemy, but the amount of necessary transfusions decreased significantly. We could follow 9 treated pts. The average follow up was 12 (1 – 30) months. Conclusion: With the combination of different endoscopic methods, including band ligation, excellent long-term results can be achieved in patients with gastric antral vascular ectasia resulting in cessation or at least significant decrease in blood loss. It is not necessary completely eradicate these lesions to get such a paramount result.