Abstract
We report the results of endoscopic laser therapy on 59 patients with upper gastrointestinal vascular ectasia. After 300 sessions, complications were two nonbleeding and three bleeding ulcers, treated successfully with endoscopic therapy. After treatment, blood transfusions were abolished in 61% and reduced in 22% of the patients, whereas 17% of the patients were nonresponders and 5% died for bleeding. Treatment outcome correlated with endoscopic healing, number of yearly transfusions, and lesions’ localization. Patients, who did not respond to laser therapy by the sixth session, showed no improvement afterwards. Four patients with persistence of bleeding despite laser therapy underwent surgery and in three of them, a long-term control of bleeding was obtained. In conclusion, laser therapy was safe and effective; nonetheless, surgical treatment should be considered, after adequate staging, for those patients receiving more than 10 blood units per year or who have undergone more than six laser sessions without improvement.
Similar content being viewed by others
References
Gordon FH, Watkinson A, Hodgson H (2001) Vascular malformations of the gastrointestinal tract. Best Pract Res Clin Gastroenterol 15:41–58
Shovlin CL (1997) Molecular defects in rare bleeding disorders: hereditary haemorrhagic telangiectasia. Thromb Haemost 78:145–150
Marchuk DA (1998) Genetic abnormalities in hereditary hemorrhagic telangiectasia. Curr Opin Hematol 5:332–338
Sebastian S, O’Morain CA, Buckley MJM (2003) Review article: current therapeutic options for gastric antral vascular ectasia. Aliment Pharmacol Ther 18:157–165
Bowmick BK (1993) Watermelon stomach treated with oral corticosteroid. J R Soc Med 86:52
Kruger R, Ryan ME, Dickson KB, Nunez JF (1987) Diffuse vascular ectasia of the gastric antrum. Am J Gastroenterol 82:421–426
Kishi K, Kinoshita Y, Kitajima N, Itoh T, Watanabe M, Kawanami C et al (1991) Two cases of gastric antral vascular ectasia—response to medical treatment. Gastroenterol Jpn 26:757–762
McCormick Pa, Oii H, Crosbie O (1998) Tranexamic acid for severe bleeding gastric antral vascular ectasia in cirrhosis. Gut 42:750–752
Nardone G, Rocco A, Balzano T, Budillon G (1999) The efficacy of octreotide therapy in chronic bleeding due to vascular abnormalities of the gastrointestinal tract. Aliment Pharmacol Ther 13:1429–1436
Van Custem E, Rutgerts P, van Trappen G (1990) Treatment of bleeding gastrointestinal vascular malformations with oestrogen progesterone. Lancet 335:953–955
Tran A, Villeneuve JP, Bilodeau M, Willems B, Marleau D, Fenyves D et al (1999) Treatment of chronic bleeding from gastric antral vascular ectasia (GAVE) with oestrogen progesterone in cirrhotic patients: an open pilot study. Am J Gastroenterol 94:2909–2911
Cales P, Voigt JJ, Payen JL, Bloom E, Berg P, Vinel JP et al (1993) Diffuse vascular ectasia of the antrum, duodenum and jejunum in a patient with nodular regenerative hyperplasia: lack of response to portosystemic shunt or surgery. Gut 34:558–561
Barbara G, De Giorgio R, Selvioli B, Stanghellini V, Corinaldesi R (1998) Unsuccessful octreotide treatment of the watermelon stomach. J Clin Gastroenterol 26:345–346
Rose JDR (1987) Endoscopic injection of alcohol for bleeding for gastroduodenal vascular anomalies. Br Med J 295:93–94
Cugia L, Carta M, Dore MP, Reali G, Massarelli G (2000) The watermelon stomach: successful treatment by monopolar electro coagulation and endoscopic injection of polidocanol. J Clin Gastroenterol 31:93–94
Binmoeller KF, Katon RM (1990) Bipolar electrocoagulation for watermelon stomach. Gastrointest Endosc 36:399–402
Stotzer PO, Willen R, Kilander AF (2002) Watermelon stomach: not only an antral disease. Gastrointest Endosc 55:897–900
Petrini JJ, Johnston J (1989) Heater probe for antral vascular ectasia. Gastrointest Endosc 35:324–328
Wahab PJ, Mulder CJ, den Hartog G, Thies JE (1997) Argon plasma coagulation in flexible gastrointestinal endoscopy; pilot experiences. Endoscopy 29:176–181
Yusoff I, Brennan F, Ormonde D, Laurence B (2002) Argon plasma coagulation for the treatment of watermelon stomach. Endoscopy 34:407–410
Sargeant IR, Loizou LA, Rampton D, Tulloch M, Bown SG (1993) Laser ablation of upper gastrointestinal vascular ectasia: long term results. Gut 34:470–475
Mathou NG, Lovat LB, Thorpe SM, Bown SG (2004) Nd:YAG laser induces long-term remission in transfusion-dependent patients with watermelon stomach. Lasers Med Sci 18:213–218
Liberski SM, McGarrity TJ, Hartle RJ, Varano V, Reynolds D (1994) The watermelon stomach: long-term outcome in patients treated with Nd:YAG laser therapy. Gastrointest Endosc 40:584–587
Gostout CJ, Viggiano TR, Ahlquist DA, Wang KK, Larson MV, Balm R (1992) The clinical and endoscopic spectrum of the watermelon stomach. J Clin Gastroenterol 15:256–263
Burak KW, Lee SS, Beck PL (2001) Portal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) syndrome. Gut 49:866–872
Norberto L, Polese L, Angriman I, Erroi F, Cecchetto A, D’Amico DF (2004) High-energy laser therapy of Barrett’s esophagus: preliminary results. World J Surg 28:350–354
Norberto L, Polese L, Angriman I, Erroi F, Cecchetto A, D’Amico DF (2005) Laser photoablation of colorectal adenomas: a 12 year experience. Surg Endosc 19:1045–1048
Geller A, Gostout CJ, Balm RK (1996) Development of hyperplastic polyps following laser therapy for watermelon stomach. Gastrointest Endosc 43:54–56
Novitsky YW, Kercher KW, Czerniach DR, Litwin DE (2003) Watermelon stomach: pathophysiology, diagnosis and management. J Gastrointest Surg 7:652–661
Proctor DD, Henderson KJ, Dziura JD, Longacre AV, White RI Jr, White RI (2005) Enteroscopic evaluation of the gastrointestinal tract in symptomatic patients with hereditary hemorrhagic telangiectasia. J Clin Gastroenterol 39:115–119
Ingrosso M, Sabbà C, Pisani A, Principi M, Gallitelli M, Cirulli A et al (2004) Evidence of small-bowel involvement in hereditary hemorrhagic telangiectasia: a capsule-endoscopic study. Endoscopy 36:1074–1079
Brandt LJ (1996) Gastric antral vascular ectasia: is there to be a consensus. Gastrointest Endosc 44:355–356
Egger C, Kreczy A, Kirchmair R, Waldenberger P, Jaschke W, Vogel W (1997) Gastric antral vascular ectasia with portal hypertension: treatment with TIPSS. Am J Gastroenterol 92:2292–2294
Bellaiche G, Nouts A, Brassier D, Ley G, Slama JL (1998) Severe iron deficiency anaemia due to diffuse antral vascular ectasia in a cirrhotic patient. Cure after surgical portacaval shunt. Gastroenterol Clin Biol 22:832–834
Spahr L, Villeneuve JP, Dufresne MP, Tasse D, Bui B, Willems B et al (1999) Gastric antral vascular ectasia in cirrhotic patients: absence of relation with portal hypertension. Gut 44:739–742
Kamath Ps, Lacerda M, Ahlquist DA, McKusick MA, Andrews JC, Nagorney DA (2000) Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis. Gastroenterology 118:905–911
Vincent C, Pomier-Layrargues G, Dagenais M, Lapointe R, Letourneau R, Roy A et al (2002) Cure of gastric antral vascular ectasia by transplantation despite persistent portal hypertension: a clue for pathogenesis. Liver Transpl 8:717–720
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Polese, L., Angriman, I., Pagano, D. et al. Laser therapy and surgical treatment in transfusion-dependent patients with upper-gastrointestinal vascular ectasia. Lasers Med Sci 21, 140–146 (2006). https://doi.org/10.1007/s10103-006-0389-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10103-006-0389-7