Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2022; 10(18): 6050-6059
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6050
Influences of etiology and endoscopic appearance on the long-term outcomes of gastric antral vascular ectasia
Hyo Jin Kwon, Si Hyung Lee, Joon Hyun Cho
Hyo Jin Kwon, Si Hyung Lee, Joon Hyun Cho, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea
Author contributions: Cho JH and Lee SH designed the study; Kwon HJ and Cho JH performed the research; Kwon HJ and Cho JH analyzed the data; Cho JH wrote the paper; Lee SH and Cho JH revised the manuscript.
Supported by the 2020 Yeungnam University Research Grant.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Yeungnam University Hospital (IRB No. 2021-10-044).
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joon Hyun Cho, MD, PhD, Associate Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, South Korea.ygowgo96@hanmail.net
Received: December 18, 2021
Peer-review started: December 18, 2021
First decision: January 23, 2022
Revised: January 31, 2022
Accepted: April 24, 2022
Article in press: April 24, 2022
Published online: June 26, 2022
Processing time: 180 Days and 20.3 Hours
Abstract
BACKGROUND

Gastric antral vascular ectasia (GAVE) has diverse associations and presumed causes, which include liver cirrhosis, chronic kidney disease, and autoimmune disease. This heterogeneity of underlying disorders suggests that the pathogenesis of GAVE may be variable.

AIM

To compare the clinical features and long-term outcomes of GAVE according to endoscopic patterns and etiologies.

METHODS

The medical records and endoscopic images of 23 consecutive patients diagnosed with GAVE by endoscopy at Yeungnam University Hospital from January 2006 to December 2020 were retrospectively reviewed. Patients were allocated to cirrhosis (16 patients) and non-cirrhosis groups (7 patients). GAVE subtypes, as determined by endoscopy, were categorized as punctate (a diffuse, honeycomb-like appearance, 17 patients) or striped (a linear, watermelon-like appearance, 6 patients).

RESULTS

All GAVE patients with cirrhosis (16/16, 100%) had a punctate pattern by endoscopy, whereas the majority of patients (6/7, 85.7%) without cirrhosis had a striped pattern (P < 0.001). Overt GAVE bleeding (10/23, 43%) was significantly more common in the non-cirrhosis group than in the cirrhosis group (6/7, 85.7% vs 4/16, 25.0%; P = 0.019), and more common in the striped group than in the punctate group (5/6, 83.3% vs 5/17, 29.4%; P = 0.052). However, mean numbers of admissions due to GAVE bleeding and argon plasma coagulation (APC) sessions to address overt bleeding were similar in the cirrhosis and non-cirrhosis groups and in the punctate and striped groups. All patients with GAVE bleeding were successfully treated by APC, and no patient died from GAVE-related blood loss during a median follow-up of 24 mo.

CONCLUSION

Punctate-type GAVE is strongly associated with liver cirrhosis, and GAVE patients without cirrhosis tend to be more prone to overt bleeding. However, the presence of cirrhosis and endoscopic patterns did not influence long-term clinical courses or outcomes in cases of overt bleeding.

Keywords: Gastric antral vascular ectasia, Cirrhosis, Endoscopy, Gastrointestinal bleeding, Argon plasma coagulation

Core Tip: The study shows that punctate (diffuse, honeycomb)-type gastric antral vascular ectasia (GAVE) is strongly associated with liver cirrhosis, whereas striped (linear, watermelon)-type GAVE is strongly associated with non-cirrhotic underlying disease. Additionally, GAVE patients without cirrhosis tended to be more prone to overt bleeding. However, the presence of cirrhosis and endoscopic GAVE patterns did not influence clinical courses or the outcomes of overt bleeding after endoscopic APC treatment. It appears that clinical manifestations are dependent on etiologies, but that etiologies do not influence clinical courses in cases of GAVE bleeding.