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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2018; 10(1): 30-36
Published online Jan 16, 2018. doi: 10.4253/wjge.v10.i1.30
Case series on multimodal endoscopic therapy for gastric antral vascular ectasia, a tertiary center experience
Tasnia Matin, Mohammed Naseemuddin, Mohamed Shoreibah, Peng Li, Kondal Kyanam Kabir Baig, Charles Mel Wilcox, Shajan Peter
Tasnia Matin, Internal Medicine, UAB Hospital, Birmingham, AL 35233, United States
Tasnia Matin, Division of Gastroenterology, University of Alabama School of Medicine, Birmingham, AL 35294, United States
Mohammed Naseemuddin, Department of Gastroenterology, Emory, Atlanta, GA 30322, United States
Mohamed Shoreibah, Kondal Kyanam Kabir Baig, Charles Mel Wilcox, Shajan Peter, Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
Peng Li, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 25294, United States
Author contributions: Matin T was responsible for design, data collection/analysis/interpretation and drafting article; Naseemuddin M was responsible for additional design, data collection and drafting article; Shoreibah M was responsible for critical revision of the article; Li P was responsible for statistical analysis of data; Kyanam Kabir Baig K was responsible for critical revision of the article for important intellectual content; Wilcox CM was responsible for critical revision of the article for important intellectual content; Peter S was responsible for conception and design, critical revision and final approval of article.
Institutional review board statement: IRB was approved by the UAB IRB board.
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: No authors had conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at tasniamatin@uabmc.edu. Specific consent not obtained from participants but data is anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tasnia Matin, MD, Division of Gastroenterology, University of Alabama School of Medicine, 1720 2nd Avenue South, BDB 380, Birmingham, AL 35294, United States. tasniamatin@uabmc.edu
Telephone: +1-205-9962459 Fax: +1-205-9756201
Received: October 27, 2017
Peer-review started: October 28, 2017
First decision: November 14, 2017
Revised: December 13, 2017
Accepted: December 29, 2017
Article in press: December 29, 2017
Published online: January 16, 2018
ARTICLE HIGHLIGHTS
Research background
At present, optimal treatment of gastric antral vascular ectasia (GAVE) is unknown but it is apparent that severe cases require multimodal therapy. The newly discovered nodular variant, from our study, appears to more often require multimodal therapy.
Research motivation
GAVE is an important cause of chronic anemia and can lead to chronic blood transfusion dependence. Having effective treatment is an important for patient quality of life.
Research objectives
Main objectives were to study patients presenting with GAVE and chronic anemia and following outcomes based on type of GAVE as well as type of intervention.
Research methods
We reviewed patients with GAVE who underwent treatment at University of Alabama at Birmingham. Included patients had an endoscopic diagnosis of GAVE with associated upper gastrointestinal bleeding or iron deficiency anemia. Medical history including demographic data and chronic medical conditions associated with GAVE were collected. Patients receiving transfusions for other issues outside of GAVE (i.e., for surgeries) were excluded.
Research results
Seven out of 15 patients had classic watermelon description for GAVE, 1/15 with diffuse/honeycomb pattern and 6/15 with nodular GAVE per EGD description. Seven out of 15 patients required multimodal treatment. Four out of six of patients with endoscopically nodular GAVE required multimodal therapy. Overall, mean pre- and post-treatment hemoglobin (Hb) values were 8.2 ± 0.8 g/dL and 9.7 ± 1.6 g/dL, respectively (P ≤ 0.05). Mean number of pRBC transfusions before and after treatment was 3.8 ± 4.3 and 1.2 ± 1.7 (P ≤ 0.05), respectively.
Research conclusions
Patients who received TTS-radiofrequency ablation and patient with multimodal therapy, both had decrease in transfusion requirements and improvement in mean Hb. Our study found that patients with nodular variant GAVE tended to require multimodal therapy more frequently. We believe patients with nodular variant GAVE would benefit from a multimodal approach.
Research perspectives
Lessons learned from this study include importance of larger study population. Future directions include involving larger patient pool and possibly attempting a prospective approach based on suggested algorithm.
