A Case of Refractory Gastric Antral Vascular Ectasia Treated Successfully With Distal Gastrectomy and Billroth II Reconstruction

Gastric antral vascular ectasia is a rare cause of upper gastrointestinal bleeding and an important cause of transfusion dependence. Although surgery should be considered when patients with gastric antral vascular ectasia become transfusion-dependent even after endoscopic treatment, surgery for such...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-02, Vol.15 (2), p.e34875
Main Authors: Itagaki, Hideya, Suzuki, Katuhiko, Endo, Tomoyuki
Format: Article
Language:English
Subjects:
Ablation
Anemia
Blood clots
Blood tests
Blood transfusions
Blood vessels
Case reports
Catheters
Clinical trials
Diabetes
Edema
Emergency medical care
Endoscopy
Gastroenterology
Gastrointestinal surgery
Hospitalization
Hypertension
Kidney diseases
Liver cirrhosis
Patients
Stomach
Veins & arteries
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Summary:Gastric antral vascular ectasia is a rare cause of upper gastrointestinal bleeding and an important cause of transfusion dependence. Although surgery should be considered when patients with gastric antral vascular ectasia become transfusion-dependent even after endoscopic treatment, surgery for such patients with cirrhosis on dialysis has not been reported. Our patient, a 62-year-old man with a history of cirrhosis and chronic kidney failure, experienced recurrent bloody stool. Upper endoscopic findings indicated a diagnosis of gastric antral vascular ectasia; therefore, we initiated therapy with argon plasma coagulation. Anemia developed, and despite a second argon plasma coagulation treatment, it remained difficult to control. During the six weeks of hospitalization, the patient received more than 40 units of red blood cells. The gastroenterologist determined that further treatment with argon plasma coagulation would increase the risk of gastric perforation; therefore, we performed distal gastrectomy with Billroth II reconstruction. The patient was discharged from the hospital 15 days after surgery and had no signs of anemia for more than one year after discharge. The case of our patient shows that although endoscopic therapy is the usual treatment for gastric antral vascular ectasia, surgery should be considered when anemia is difficult to control.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.34875