Abstract
Watermelon Stomach: Recurrent Upper Gastrointestinal Bleeding secondary to Gastric Antral Vascular Ectasia in an Elderly Female with Pseudocirrhosis
Raymundo, Nikko Theodore; Gopez-Cervantes, Juliet; Dumagpi, Joseph Erwin Lin, Tim Lawrence; Siray, Ma. Felina; Garcia, Maxine Andrea
Institute of Digestive and Liver Diseases, St. Luke’s Medical Center, Global City, Philippines
Significance: Gastric antral vascular ectasia (GAVE) is a rare but critical cause of upper gastrointestinal bleeding which commonly presents with iron deficiency anemia and occult bleeding. GAVE is commonly associated with cirrhosis, autoimmune disorders and connective tissue diseases.
Clinical Presentation: We present a 76-year old female, known case of breast cancer stage IV who was admitted due to melena with initial hemoglobin of 6.8mg/dl. Upper endoscopy was done showing GAVE. PET CT showed pseudocirrhotic changes no evidence of portal hypertension or collateral vessel formation. Melena recurred and repeat EGD was still consistent with GAVE. Capsule endoscopy showed no active bleeding in the small intestine. Due to the frequent recurrence of melena, the patient underwent three sessions of Argon Plasma Coagulation (APC), the second necessitating hemospray and the third with supplemental rubber band ligation (RBL). Prior to discharge, she was started on subcutaneous octreotide. Six months post-discharge, she followed up clinically well with resolution of anemia and no recurrence of bleeding. The etiology of GAVE in this case is likely related to the pseudocirrhosis from metastatic breast cancer. As exhibited in this case, APC is known to have a high recurrence rate with multiple sessions needed to attain eradication. RBL has more recently been applied for the treatment of GAVE especially for cases refractory to APC, with higher rates of bleeding cessation. Endoscopic therapy has always been the mainstay of treatment for GAVE. However, medical management with octreotide can be used as adjunct for maintenance and prophylaxis.
Important Dates to Remember
| JRRE Activities 2023-2024 |
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|---|---|
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