UGI Stomach Duodenum-TREATMENT OF GASTRIC ANTRAL VASCULAR ECTASIA WITH ENDOSCOPIC BAND LIGATION

Video Transcription

This is a case of bleeding nodular gave with endoscopic band ligation. Our patient is a 76-year-old woman with a history of breast cancer who presented with  iron deficiency anemia which required intermittent blood transfusions for symptomatic anemia. She underwent upper endoscopy within the past year, which was notable for erythema  in the gastric. Colonoscopy did not reveal a source of GI bleeding. We proceeded with video capsule endoscopy, which was remarkable for bleeding nodular  gastric antral vascular ectasias, also known as GAVE. And we did not find any other sources of potential GI blood loss.  An EGD was then performed, which re-demonstrated bleeding nodular GAVE. And given the nodularity, we elected to pursue endoscopic band ligation, or EBL.  Prospective data suggested EBL may be more effective in treating nodular GAVE with greater improvement in clinical endpoints for GAVE therapy.  EBL also may result in deeper tissue injury, both mucosal and deeper submucosal tissue ischemia as compared to thermal therapy, where the injury is more limited to the mucosa and  superficial mucosa. And after careful inspection, we utilized a multi-band ligator, which is conventionally  used for variceal bleeding, and successfully deployed six bands to the effect of GAVE. And this efficiently and effectively treated the majority of the affected mucosa in the  antrum. The patient did experience some transient nausea following the procedure, which resolved quickly.  And this adverse event has been described in about 5% of patients undergoing endoscopic band ligation of nodular GAVE.  Following the endoscopic therapy, the patient didn't require any further blood transfusions. A follow-up upper endoscopy six weeks after the initial therapy showed marked reduction  in the antrum mucosa. As we see here, seemingly the GAVE had been treated well, and there was no suggestion of ongoing bleeding.  In conclusion, this case demonstrates how endoscopic band ligation can be an effective alternative to thermal therapy and treatment of gastrointestinal vascular atasia.

Video Summary

In this video, the case of a 76-year-old woman with a history of breast cancer and iron deficiency anemia is discussed. The patient underwent various procedures like upper endoscopy and colonoscopy to identify the source of gastrointestinal bleeding. Eventually, bleeding nodular gastric antral vascular ectasias (GAVE) were found, and endoscopic band ligation (EBL) was chosen as a treatment option. EBL was performed using a multi-band ligator, successfully treating the affected mucosa. The patient experienced transient nausea but didn't require further blood transfusions. Follow-up endoscopy showed a significant reduction in the antrum mucosa, indicating successful treatment of GAVE with EBL. Overall, this case highlights the effectiveness of EBL as an alternative to thermal therapy for gastrointestinal vascular atasia.

Asset Subtitle

Honorable Mention

Keywords

76-year-old woman

gastrointestinal bleeding

endoscopic band ligation (EBL)

bleeding nodular gastric antral vascular ectasias (GAVE)

antrum mucosa