2026 Volume 68 Issue 1 Pages 28-34
Gastric antral vascular ectasia (GAVE) is endoscopically characterized by a radial or diffuse telangiectasia of the gastric antrum. GAVE is associated with various conditions, including liver cirrhosis, chronic renal failure, aortic valve stenosis, and autoimmune diseases. GAVE is prone to bleeding due to contact with food residue and peristalsis, causing gastrointestinal bleeding and iron deficiency anemia. During EGD, insufflation distends the gastric wall and reduces superficial capillary blood flow, thereby making GAVE less visible. Therefore, these lesions can be misdiagnosed as gastritis on EGD and may not be recognized as a source of obscure gastrointestinal bleeding. If GAVE is observed on EGD without active bleeding, it is often difficult to determine whether it is the cause of the gastrointestinal bleeding and whether hemostatic treatment is necessary.
In this report, we present the cases of two patients who had previously been treated with argon plasma coagulation (APC) for GAVE. Though EGD showed no active bleeding, video capsule endoscopy (VCE) revealed active bleeding from GAVE, confirming it as the bleeding source. The first patient, a 59-year-old male, had melena and hepatic encephalopathy associated with gastrointestinal bleeding. The second patient, a 72-year-old male, had melena and anemia requiring frequent blood transfusions. APC effectively improved anemia and relieved melena in both patients. Therefore, in patients with anemia and melena, when EGD fails to detect active bleeding from GAVE, VCE may aid in identifying small intestinal bleeding and determining whether hemostatic intervention is required.
