Less is more: Minimalist approach to hyperplastic reaction after radiofrequency in Gastric Antral Vascular Ectasia

Introduction: The management of microscopic digestive blood losses can be challenging. We present a case where isolated endoscopic therapy led to worsening of gastrointestinal bleeding.

Endoscopy: A 79-year-old male with ischemic heart disease and terminal chronic kidney disease on hemodialysis, with a history of recurrent admissions for upper gastrointestinal bleeding secondary to GAVE (gastric antral vascular ectasia), was managed endoscopically with argon plasma coagulation and HALO radiofrequency ablation. During subsequent follow-up, due to weekly transfusion requirements, a control gastroscopy was performed, revealing numerous erythematous and eroded sessile polyps up to 15 mm in the antrum, histologically consistent with hyperplastic polyps. After reviewing the literature, a therapeutic change was made from proton pump inhibitors (PPIs) to famotidine, resulting in significant improvement in hemoglobin levels, with only one blood unit transfusion required over the following year. A gastroscopy performed 10 months later showed clear regression in both the number and size of the polyps, with no signs of GAVE.

Conclusions: After endoscopic thermal therapies such as coagulation or radiofrequency, hyperplastic reactions in the digestive mucosa can occur, also favoured by the trophic effect induced by hypergastrinemia secondary to PPIs. Despite recommendations for polypectomy in the context of iron-deficiency anemia, growing evidence suggests that discontinuing PPI treatment and replacing it with other antisecretory agents, particularly H2 receptor antagonists, leads to regression of polyp size and reduced blood loss, significantly impacting quality of life [1] [2].

 

Scroll to top

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Yasugi K, Haruma K, Kawanaka M, Suehiro M, Nakamura J, Urata N, Tanikawa T, Oka T, Monobe Y, Fujita T, Kawamoto H.. Disappearance of Gastric Hyperplastic Polyps after the Discontinuation of Proton Pump Inhibitor in a Patient with Liver Cirrhosis. Case Rep Gastroenterol 2021; 15 (1): 202-209 PMID: 33790706
• 2 Iwamuro M, Shiraha H, Okada H.. Gastric polyps' regression after potassium-competitive acid blocker cessation. J Gen Fam Med 2022; 23 (5): 358-359 PMID: 36093226

Publication History

Article published online:
27 March 2025