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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 A

DOI: 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/AuthorNo. of reported casesAge/SexPresentationCKD /ESRD 2ry toLiver diseasesDuration on dialysis before diagnosis of GAVEInitial Hgb (g/dL)
11996 Yorioka N, et al []12 170/FAnemiaChronic pyelonephritisNo9 years4.1
21996 Hermans C, et al []20 163/MAnemiaChronic glomerulone- phritisNo6 years6.3
31998 Chien CC, et al []13 150/FAnemiaNANo5 yearsNA
42000 Fábián G, et al []21 177/FAnemiaHypertensive NephropathyNo2 years3.6
52003Tomori K, et al []14 269/MAnemia HematemesisHypertensive NephropathyNo6 monthsNA
657/FAnemiaHypertensive NephropathyNo2 yearsNA
72005 Pljesa S, et al []22 154/FAnemia MelenaChronic pyelonephritisNo7 years4
82006 Stefanidis I, et al []23 261/FMelena Hypotension during dialysisAutosomal dominant polycystic kidney diseaseNo10 months7.6
972/FAnemia MelenaChronic interstitial nephritisNo2 years (21 months)NA
102007 George P, et al []24 142/MAnemia MelenaChronic glomerulone- phritis Post-renal transplantation (15 years ago) Chronic allograft nephropathyDecompensated cirrhosis 2 ry to hepatitis BPost-renal transplantation4
112009 Nguyen H, et al []4 163/FAbdominal pain Vomiting MelenaDiabetic and Hypertensive NephropathyChronic hepatitis C infection, Portal HTNNA6.8
122010 Lin W-H, et al []25 138/FAnemia MelenaNANo7 yearsNA
132011 Iguchi A, et al []6 367/FAnemiaChronic glomerulonephritisNoNot on dialysis5.8
1461/FAnemia MelenaHepatorenal syndromeAlcoholic liver cirrhosisNot on dialysis4.8
1566/FAnemiaAutosomal dominant polycystic kidney diseaseNoNot on dialysis4.8
162012 Lata S, et al []26 1Middle age/FAnemia MelenaHypertensive NephropathyChronic liver disease 2ry to hepatitis C virus6 years4.3
172013 Jinga M, et al []27 142/FAnemia Abdominal painSLENo3 years (40 months)6.7
182014 Pisharam JK, et al []15 459/FAnemiaDiabetic NephropathyNo4 years8
1967/MAnemia HematemesisDiabetic NephropathyNo5 years5.7
2071/FMelenaDiabetic NephropathyChronic hepatitis B infection2 years5.6
2150/FAnemiaDiabetic NephropathyNo3 years8.3
222014 Ahn Y, et al []5 152/FAnemia MelenaDiabetic and Hypertensive NephropathyNon-alcoholic liver cirrhosis complicated byortal HTN2 years5.5
232014 Kilincalp S, et al []28 154/MAnemiaHypertensive Nephropathy Post-renal transplantation (5 years ago)NoPost-renal transplantation5.8
242014 Shimamura Y, et al []29 164/FAnemia UGIBDiabetic NephropathyNoNA6.7
252015 Lee DJR, et al []16 140/FAnemia Melena Hematemesis Hypotension during dialysisHypertensive NephropathyNo9 years4.8
262018 Rimševičius L, et al []30 466/FAnemia MelenaDiabetic and Hypertensive NephropathyNo3 years6
2775/MAnemia MelenaHypertensive NephropathyNo5 years11.8
2864/MAnemiaChronic pyelonephritisNo5 years9.8
2980/MAnemia MelenaNANoNot on dialysis7.7
302019 Santos S, et al []31 149/MAnemia MelenaChronic glomerulonephritisNoNA6.3
312020 Kang SH, et al []32 176/FAnemia Melena HematemesisSLENo5 months5.5
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 findingMedical managementEndoscopic managementSurgical managementManagement outcome
11 Superficial erosion in the gastric antrum2 Red linear streaks ascending to the pylorusConservativeNoNoBlood transfusion dependent which improve within 3 months of HD cessation and CAPD initiation
2Longitudinal folds of dilated vessels radiating from the pylorus NormalHormonal therapy (Estrogen and Progesterone)NoNoSuccessful
31 Antral gastritis2 Typical picture of watermelon stomachHormonal therapy (Norethisterone and Ethynyloestradol)NoNoSuccessful
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 colonHormonal therapy (Estrogen and Progesterone)NoNoSuccessful
51 oozing in the antrum, and gastritis and esophagitis with sliding hernia2 Typical picture of watermelon stomachNoAPCNoSuccessful
6Oozing in the antrum with diffuse vasodilation in the antrumNoAPCNoSuccessful
7Visible 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 NormalNoSclerotherapy (Electrocoagulation and APC were not available)Total gastrectomySuccessful
8– Characteristic antral appearance of watermelon stomach– Erythematous stripes in the cardia– Diaphragmatic herniaNoElectrocoagulation (10 sessions)NoSuccessful
9Typical watermelon stomach (longitudinal rugal folds transversing the antrum and converging on the pylorus)NoLaser photocoagulation ElectrocoagulationNoDeath
10Portal hypertensive gastropathy with gastric antral vascular ectasia NormalNoElectrocoagulation (4 sessions) APCNoDeath
11– Esophageal varices and PHG 2 years before GAVE dxExtensive vascular ectasias and patchy erythema in the distal antrum HemorrhoidsNoNot tried due to diffuse and advanced vascular ectasiasSubtotal gastrectomySuccessful
12– Multiple esophageal ulcers, gastric ulcers, and gastritis. before GAVE dx– Ectatic vessels along the longitudinal folds of the antrumNoAPC (5 sessions)NoSuccessful
13Watermelon stomach at the antrumNoAPC (2 sessions)NoSuccessful
14Diffuse antral vascular ectasiaNoAPC (2 sessions)NoSuccessful
15Watermelon stomachNoAPC (3 sessions)NoSuccessful
16– Multiple linear gastric vascular malformations in the antrum with spurt oozingEctasias in the cardia and the duodenum NormalNoAPCNoSuccessful
17Visible columns of red tortuous ectatic vessels along the longitudinal folds of the antrumNoAPC (Multiple sessions)NoSuccessful
181– Hemorrhagic antral gastritis with self-limiting oozing2– Diffuse erythematous patches in the antrum– Vascular ectasia located at the gastro-esophageal junctionNoCombination of heater probe and coagulation with open snare (2 sessions) – APC was not availableNoDeath due to sepsis
191– Gastritis and a fundal polyp2– Mild esophagitis, some fresh blood in the distal stomach and multiple antral folds with erythematous patchesNoThermal coagulation (3 sessions)NoDeath due to sepsis
201– Antral gastritis and few telangiectasias2– Fresh blood in the antrum with prominent antral folds and gastritisNoAdrenaline injection Thermal coagulationNoBlood transfusion dependent
21Two prominent antral folds and 2 linear erythematous streaksConservative NoNoSuccessful
22Single gastric antral angiodysplastic lesion with hemorrhage and multiple gastric angioectasias with no bleedingNoAPC (Multiple sessions)Gastrectomy was considered but patient was high riskBlood transfusion dependent
23Raised erythematous stripes radiating from pylorus up to the lower part of gastric bodyNoAPC (3 sessions)NoSuccessful
24Red tortuous ectatic vessels along the longitudinal folds of the antrumNoAPC (3 sessions)NoSuccessful
251 Distal erosive esophagitis and intense antral erosive gastritis2 Longitudinal antral folds containing visible stripes of tortuous red ecstatic vessels with bleeding NormalNoAPCNoSuccessful
26Multiple linear gastric vascular malformations with signs of bleedingNoAPCNoSuccessful
27Multiple linear gastric vascular malformations in the antrum, with 3 mm lesions and no signs of bleedingNoAPCNoSuccessful
28Multiple l ar gastric vascular malformations in the antrum without any signs of bleedingNoAPCNoSuccessful
29Multiple linear gastric vascular malformations in the antrum with small signs of bleedingNoAPCNoSuccessful
30Multiple gastric angiodysplasias arranged in radiating streaks with active bleedingBevacizumabAPCNoSuccessful
31Multiple erythematous raised hyperemic mucosal lesions at the distal antrum without active bleedingNoAPC (8 sessions)NoBlood 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.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923