A CASE OF RECURRENT GASTRIC VASCULAR ANTRAL ECTASIA TREATED WITH ENDOSCOPIC SUBMUCOSAL DISSECTION

Abstract

A 53-year-old man visited at our hospital for examination of intermittent upper gastrointestinal bleeding and severe anemia which has persisted for five years. He had started hemodialysis for chronic renal failure 11 years previously. Upper GI endoscopy showed multiple longitudinal stripes of red vessels radiating in a spoke-like fashion from the pylorus to the antrum. We diagnosed this as gastric antral vascular ectasia (GAVE) and considered it was the cause of the bleeding. Argon plasma coagulation (APC) was performed but the patient was repeatedly transfused for intermittent tarry stools due to recurrence of the GAVE. We performed endoscopic submucosal dissection (ESD) of about one third of the GAVE lesion having received informed consent. The maximum size of the resected specimen was 60 mm. The histopathological findings were consistent with previous reports on GAVE ; dilatation of mucosal capillaries, fibromuscular hyperplasia of the lamina propria and vascular dilatation in the submucosa. The patient was asymptomatic and doing well 10 months after the ESD procedure. Endoscopic follow-up examinations showed no recurrence of GAVE in the area of the resection. We considered this case was important because it was to our knowledge the first instance of recurrent GAVE treated with ESD.