13 March 2023: Articles
Successful Surgical Management of Gastric Antral Vascular Ectasia in a Patient with End-Stage Renal Disease: A Case Report and Literature Review
Unknown etiology, Management of emergency care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology
Bader H. Alsaeed B , Ayesha A. AlAbdulqader B , Ali A. Al-Qadhi B , Hawra A. Alaswad B , Mohammed S. Foula A* , Saeed J. Alshomimi ADOI: 10.12659/AJCR.938543
Am J Case Rep 2023; 24:e938543
Table 1. Literature review summary including all reported cases with GAVE in patients with CKD from 1996 to 2020.
| Case No. | Year/Author | No. of reported cases | Age/Sex | Presentation | CKD /ESRD 2ry to | Liver diseases | Duration on dialysis before diagnosis of GAVE | Initial Hgb (g/dL) |
|---|---|---|---|---|---|---|---|---|
| 1 | 1996 Yorioka N, et al []12 | 1 | 70/F | Anemia | Chronic pyelonephritis | No | 9 years | 4.1 |
| 2 | 1996 Hermans C, et al []20 | 1 | 63/M | Anemia | Chronic glomerulone- phritis | No | 6 years | 6.3 |
| 3 | 1998 Chien CC, et al []13 | 1 | 50/F | Anemia | NA | No | 5 years | NA |
| 4 | 2000 Fábián G, et al []21 | 1 | 77/F | Anemia | Hypertensive Nephropathy | No | 2 years | 3.6 |
| 5 | 2003Tomori K, et al []14 | 2 | 69/M | Anemia Hematemesis | Hypertensive Nephropathy | No | 6 months | NA |
| 6 | 57/F | Anemia | Hypertensive Nephropathy | No | 2 years | NA | ||
| 7 | 2005 Pljesa S, et al []22 | 1 | 54/F | Anemia Melena | Chronic pyelonephritis | No | 7 years | 4 |
| 8 | 2006 Stefanidis I, et al []23 | 2 | 61/F | Melena Hypotension during dialysis | Autosomal dominant polycystic kidney disease | No | 10 months | 7.6 |
| 9 | 72/F | Anemia Melena | Chronic interstitial nephritis | No | 2 years (21 months) | NA | ||
| 10 | 2007 George P, et al []24 | 1 | 42/M | Anemia Melena | Chronic glomerulone- phritis Post-renal transplantation (15 years ago) Chronic allograft nephropathy | Decompensated cirrhosis 2 ry to hepatitis B | Post-renal transplantation | 4 |
| 11 | 2009 Nguyen H, et al []4 | 1 | 63/F | Abdominal pain Vomiting Melena | Diabetic and Hypertensive Nephropathy | Chronic hepatitis C infection, Portal HTN | NA | 6.8 |
| 12 | 2010 Lin W-H, et al []25 | 1 | 38/F | Anemia Melena | NA | No | 7 years | NA |
| 13 | 2011 Iguchi A, et al []6 | 3 | 67/F | Anemia | Chronic glomerulonephritis | No | Not on dialysis | 5.8 |
| 14 | 61/F | Anemia Melena | Hepatorenal syndrome | Alcoholic liver cirrhosis | Not on dialysis | 4.8 | ||
| 15 | 66/F | Anemia | Autosomal dominant polycystic kidney disease | No | Not on dialysis | 4.8 | ||
| 16 | 2012 Lata S, et al []26 | 1 | Middle age/F | Anemia Melena | Hypertensive Nephropathy | Chronic liver disease 2ry to hepatitis C virus | 6 years | 4.3 |
| 17 | 2013 Jinga M, et al []27 | 1 | 42/F | Anemia Abdominal pain | SLE | No | 3 years (40 months) | 6.7 |
| 18 | 2014 Pisharam JK, et al []15 | 4 | 59/F | Anemia | Diabetic Nephropathy | No | 4 years | 8 |
| 19 | 67/M | Anemia Hematemesis | Diabetic Nephropathy | No | 5 years | 5.7 | ||
| 20 | 71/F | Melena | Diabetic Nephropathy | Chronic hepatitis B infection | 2 years | 5.6 | ||
| 21 | 50/F | Anemia | Diabetic Nephropathy | No | 3 years | 8.3 | ||
| 22 | 2014 Ahn Y, et al []5 | 1 | 52/F | Anemia Melena | Diabetic and Hypertensive Nephropathy | Non-alcoholic liver cirrhosis complicated byortal HTN | 2 years | 5.5 |
| 23 | 2014 Kilincalp S, et al []28 | 1 | 54/M | Anemia | Hypertensive Nephropathy Post-renal transplantation (5 years ago) | No | Post-renal transplantation | 5.8 |
| 24 | 2014 Shimamura Y, et al []29 | 1 | 64/F | Anemia UGIB | Diabetic Nephropathy | No | NA | 6.7 |
| 25 | 2015 Lee DJR, et al []16 | 1 | 40/F | Anemia Melena Hematemesis Hypotension during dialysis | Hypertensive Nephropathy | No | 9 years | 4.8 |
| 26 | 2018 Rimševičius L, et al []30 | 4 | 66/F | Anemia Melena | Diabetic and Hypertensive Nephropathy | No | 3 years | 6 |
| 27 | 75/M | Anemia Melena | Hypertensive Nephropathy | No | 5 years | 11.8 | ||
| 28 | 64/M | Anemia | Chronic pyelonephritis | No | 5 years | 9.8 | ||
| 29 | 80/M | Anemia Melena | NA | No | Not on dialysis | 7.7 | ||
| 30 | 2019 Santos S, et al []31 | 1 | 49/M | Anemia Melena | Chronic glomerulonephritis | No | NA | 6.3 |
| 31 | 2020 Kang SH, et al []32 | 1 | 76/F | Anemia Melena Hematemesis | SLE | No | 5 months | 5.5 |
| CKD – chronic kidney disease; ESRD – end-stage renal disease; F – female; M – male; NA – not available. * Patient died from a new stroke; ** Patient died later from sepsis; # only managed by Iron and Recombinant Human Erythropoietin. | ||||||||
| Case No. | EGD/Colonoscopy finding | Medical management | Endoscopic management | Surgical management | Management outcome | |||
| 1 | 1 Superficial erosion in the gastric antrum2 Red linear streaks ascending to the pylorus | Conservative | No | No | Blood transfusion dependent which improve within 3 months of HD cessation and CAPD initiation | |||
| 2 | Longitudinal folds of dilated vessels radiating from the pylorus Normal | Hormonal therapy (Estrogen and Progesterone) | No | No | Successful | |||
| 3 | 1 Antral gastritis2 Typical picture of watermelon stomach | Hormonal therapy (Norethisterone and Ethynyloestradol) | No | No | Successful | |||
| 4 | – Some erosions in the corpus of the stomach and slightly protruding, parallel longitudinal antral streaks converging on the pylorus– Two angiodysplastic lesions in the postbulbar duodenum – Diffuse atrophic changes of the intestinal mucosa with several angiodysplasias, 5–7 mm in diameter– Some diverticuli in the sigmoid colon | Hormonal therapy (Estrogen and Progesterone) | No | No | Successful | |||
| 5 | 1 oozing in the antrum, and gastritis and esophagitis with sliding hernia2 Typical picture of watermelon stomach | No | APC | No | Successful | |||
| 6 | Oozing in the antrum with diffuse vasodilation in the antrum | No | APC | No | Successful | |||
| 7 | Visible columns of vessels transversing the antrum in longitudinal folds and converging in the pylorus, with clear red spots and surrounding hyperemy covered by drops of fresh blood Normal | No | Sclerotherapy (Electrocoagulation and APC were not available) | Total gastrectomy | Successful | |||
| 8 | – Characteristic antral appearance of watermelon stomach– Erythematous stripes in the cardia– Diaphragmatic hernia | No | Electrocoagulation (10 sessions) | No | Successful | |||
| 9 | Typical watermelon stomach (longitudinal rugal folds transversing the antrum and converging on the pylorus) | No | Laser photocoagulation Electrocoagulation | No | Death | |||
| 10 | Portal hypertensive gastropathy with gastric antral vascular ectasia Normal | No | Electrocoagulation (4 sessions) APC | No | Death | |||
| 11 | – Esophageal varices and PHG 2 years before GAVE dxExtensive vascular ectasias and patchy erythema in the distal antrum Hemorrhoids | No | Not tried due to diffuse and advanced vascular ectasias | Subtotal gastrectomy | Successful | |||
| 12 | – Multiple esophageal ulcers, gastric ulcers, and gastritis. before GAVE dx– Ectatic vessels along the longitudinal folds of the antrum | No | APC (5 sessions) | No | Successful | |||
| 13 | Watermelon stomach at the antrum | No | APC (2 sessions) | No | Successful | |||
| 14 | Diffuse antral vascular ectasia | No | APC (2 sessions) | No | Successful | |||
| 15 | Watermelon stomach | No | APC (3 sessions) | No | Successful | |||
| 16 | – Multiple linear gastric vascular malformations in the antrum with spurt oozingEctasias in the cardia and the duodenum Normal | No | APC | No | Successful | |||
| 17 | Visible columns of red tortuous ectatic vessels along the longitudinal folds of the antrum | No | APC (Multiple sessions) | No | Successful | |||
| 18 | 1– Hemorrhagic antral gastritis with self-limiting oozing2– Diffuse erythematous patches in the antrum– Vascular ectasia located at the gastro-esophageal junction | No | Combination of heater probe and coagulation with open snare (2 sessions) – APC was not available | No | Death due to sepsis | |||
| 19 | 1– Gastritis and a fundal polyp2– Mild esophagitis, some fresh blood in the distal stomach and multiple antral folds with erythematous patches | No | Thermal coagulation (3 sessions) | No | Death due to sepsis | |||
| 20 | 1– Antral gastritis and few telangiectasias2– Fresh blood in the antrum with prominent antral folds and gastritis | No | Adrenaline injection Thermal coagulation | No | Blood transfusion dependent | |||
| 21 | Two prominent antral folds and 2 linear erythematous streaks | Conservative | No | No | Successful | |||
| 22 | Single gastric antral angiodysplastic lesion with hemorrhage and multiple gastric angioectasias with no bleeding | No | APC (Multiple sessions) | Gastrectomy was considered but patient was high risk | Blood transfusion dependent | |||
| 23 | Raised erythematous stripes radiating from pylorus up to the lower part of gastric body | No | APC (3 sessions) | No | Successful | |||
| 24 | Red tortuous ectatic vessels along the longitudinal folds of the antrum | No | APC (3 sessions) | No | Successful | |||
| 25 | 1 Distal erosive esophagitis and intense antral erosive gastritis2 Longitudinal antral folds containing visible stripes of tortuous red ecstatic vessels with bleeding Normal | No | APC | No | Successful | |||
| 26 | Multiple linear gastric vascular malformations with signs of bleeding | No | APC | No | Successful | |||
| 27 | Multiple linear gastric vascular malformations in the antrum, with 3 mm lesions and no signs of bleeding | No | APC | No | Successful | |||
| 28 | Multiple l ar gastric vascular malformations in the antrum without any signs of bleeding | No | APC | No | Successful | |||
| 29 | Multiple linear gastric vascular malformations in the antrum with small signs of bleeding | No | APC | No | Successful | |||
| 30 | Multiple gastric angiodysplasias arranged in radiating streaks with active bleeding | Bevacizumab | APC | No | Successful | |||
| 31 | Multiple erythematous raised hyperemic mucosal lesions at the distal antrum without active bleeding | No | APC (8 sessions) | No | Blood transfusion dependent | |||
| CKD – chronic kidney disease; ESRD – end-stage renal disease; F – female; M – male; NA – not available. * Patient died from a new stroke; ** Patient died later from sepsis; # only managed by Iron and Recombinant Human Erythropoietin. | ||||||||