Fortuna L, Bottari A, Bisogni D, Coratti F, Giudici F, Orlandini B, Dragoni G, Cianchi F, Staderini F
Digestive Surgery Unit, AOU Careggi, Firenze, Italy.
Digestive Surgery Unit, AOU Careggi, Firenze, Italy.
Int J Surg Case Rep. 2022 Sep;98:107474. doi: 10.1016/j.ijscr.2022.107474. Epub 2022 Aug 3.
Gastric Antral Vascular Ectasia is a rare disorder that causes up to 4 % of severe acute gastrointestinal bleeding. It affects elderly females with iron deficiency anemia due to chronic blood loss as a common presenting sign.
We report the case of a 70-year-old man admitted to the Urgency Department for severe asthenia associated with abdominal pain and severe anemia. An urgent upper endoscopic examination showed antral hyperemic streaks and vascular ectasias extending from the pyloric ring to the gastric body as well as signs of recent bleeding. Histological results demonstrated the pathognomonic features of GAVE.
The first line treatment is considered argon plasma coagulation (APC), given its wider availability, safety, efficacy and cost-effectiveness. In current literature, other therapies and different types of endoscopic treatments have been proposed, such as EBL, RFA and Yag: laser. To date, there is no specific recommendation that privileges one method over another in the treatment of GAVE, although APC has proven effective and even better in terms of complications and costs than the other techniques.
In our experience, endoscopic coagulation with APC probes is a relatively easy-to-use technique with low cost, minimal invasiveness and provides immediate results. On the other hand, a standardized algorithm is also required concerning to the different subtypes to give the best treatment in every case.
胃窦血管扩张症是一种罕见疾病，导致高达4%的严重急性胃肠道出血。它常见于老年女性，因慢性失血导致缺铁性贫血为常见的表现症状。
我们报告一例70岁男性患者，因严重乏力伴腹痛和严重贫血入住急诊科。紧急上消化道内镜检查显示胃窦充血条纹以及从幽门环延伸至胃体的血管扩张，还有近期出血迹象。组织学结果显示了胃窦血管扩张症的特征性表现。
鉴于氩离子凝固术（APC）更易获得、安全、有效且具有成本效益，因此被视为一线治疗方法。在当前文献中，已提出其他疗法及不同类型的内镜治疗，如内镜下止血（EBL）、射频消融（RFA）和钇铝石榴石激光（Yag：激光）。迄今为止，在胃窦血管扩张症的治疗中，尚无特定建议表明一种方法优于另一种方法，尽管APC已被证明有效，且在并发症和成本方面比其他技术更具优势。
根据我们的经验，使用APC探头进行内镜凝固术是一种相对易于使用的技术，成本低、创伤小且能立即见到效果。另一方面，对于不同亚型还需要一种标准化算法，以便在每种情况下都能提供最佳治疗。
