Endoscopy 2018; 50(04): S154
DOI: 10.1055/s-0038-1637498
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

CONFOCAL LASER ENDOMICROSCOPY IN THE EVALUATION OF GASTRIC ANTRAL VASCULAR ECTASIAS

A Martínez-Alcalá García
1   Hospital Universitario Infanta Leonor, Especialista Aparato Digestivo, Madrid, Spain
,
S Suganda
2   University of Alabama at Birmingham, Gastroenterology and Hepatology, Birmingham, United States
,
RD Stibolt
3   University of Alabama at Birmingham, School of Medicine, Birmingham, United States
,
L Council
4   University of Alabama at Birmingham, Pathology, Birmingham, United States
,
A Mir Ahmed
2   University of Alabama at Birmingham, Gastroenterology and Hepatology, Birmingham, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available ateRef
 

Aims:

Gastric antral vascular ectasia (GAVE) can account for up to 4% of non-variceal upper GI bleeding. The diagnosis is often based on endoscopic appearance or histology. Common endoscopic findings include the “watermelon stomach” appearance described as linear erythematous vessels radiating from the pylorus. However, GAVE may also present with a diffuse punctate or nodular pattern. Confirmation of GAVE involves the histologic findings of dilated ectatic vessels of the mucosa and submucosa, vascular thrombosis in the vessels of the lamina propria (fibrin microthrombi), fibromuscular hyperplasia of the lamina propria secondary to edema/congestion and reactive changes of the foveolar epithelium. An immunohistochemical platelet marker, CD61, is found more often in GAVE. Confocal laser endomicroscopy can provide cellular details up to 1000 micrometers from the mucosal surface. In this study, confocal patterns of GAVE were evaluated.

Methods:

A retrospective review of a prospectively collected database was conducted as part of a pilot study. As part of routine upper endoscopy fluorescein was administered and confocal endomicroscopy findings were recorded, endoscopic findings were described and a biopsy was taken.

Results:

Four patients with history of GAVE with prior treatment were evaluated by CLE. Our imaging demonstrated dilated, ectatic vessels in all patients, peri-vascular edema and dark clumps, which may represent fibrin microthrombi. Biopsies were only performed in two patients and demonstrated gastritis. There were no patient complications.

Conclusions:

Our findings suggest that CLE may be useful in identifying GAVE especially when the endoscopic findings are not clear and may play a role in monitoring response to therapy. The most common finding was the presence of dilated vasculature. However, all patients had prior therapy. Further studies validating the CLE findings in GAVE and changes associated with treatment response are warranted.