Kwon Hyo Jin, Lee Si Hyung, Cho Joon Hyun
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea.
World J Clin Cases. 2022 Jun 26;10(18):6050-6059. doi: 10.12998/wjcc.v10.i18.6050.
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.
To compare the clinical features and long-term outcomes of GAVE according to endoscopic patterns and etiologies.
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).
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 ( < 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% 4/16, 25.0%; = 0.019), and more common in the striped group than in the punctate group (5/6, 83.3% 5/17, 29.4%; = 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.
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.
胃窦血管扩张症（GAVE）有多种关联因素及推测病因，包括肝硬化、慢性肾脏病和自身免疫性疾病。这些潜在疾病的异质性表明GAVE的发病机制可能存在差异。
根据内镜下表现和病因比较GAVE的临床特征及长期预后。
回顾性分析2006年1月至2020年12月在岭南大学医院经内镜诊断为GAVE的23例连续患者的病历及内镜图像。患者分为肝硬化组（16例）和非肝硬化组（7例）。根据内镜检查确定的GAVE亚型分为点状（弥漫性蜂窝状外观，17例）或条纹状（线性西瓜样外观，6例）。
所有肝硬化的GAVE患者（16/16，100%）内镜下表现为点状，而大多数无肝硬化的患者（6/7，85.7%）表现为条纹状（P<0.001）。显性GAVE出血（10/23，43%）在非肝硬化组比肝硬化组更常见（6/7，85.7%对4/16，25.0%；P=0.019），且在条纹状组比点状组更常见（5/6，83.3%对5/17，29.4%；P=0.052）。然而，肝硬化组和非肝硬化组以及点状组和条纹状组因GAVE出血的平均住院次数和用于处理显性出血的氩等离子体凝固（APC）治疗次数相似。所有GAVE出血患者均通过APC成功治疗，在中位随访24个月期间，无患者死于GAVE相关失血。
点状型GAVE与肝硬化密切相关，无肝硬化的GAVE患者更容易发生显性出血。然而，肝硬化的存在和内镜下表现并未影响显性出血病例的长期临床病程或预后。
