Laparoscopic Surgical Treatment for Refractory Gastric Antral Vascular Ectasia

Abstract

Gastric antral vascular ectasia (GAVE) is an angiodysplastic disorder of unclear etiology and rare cause of upper gastrointestinal bleeding. Endoscopic findings of hyperemic antral folds with dilated, tortuous vessels extending radially from the pylorus are diagnostic. Ectatic submucosal capillaries, microvascular fibrin thrombosis, and fibromuscular hyperplasia in the lamina propria are distinctive histologic features. Diverse treatment options are available, ranging from conservative medical or endoscopic therapy to surgical resection of affected gastric region. Surgery is the only known curative treatment and is traditionally pursued after failure of conservative therapy, as high postoperative mortality has been reported. A case of refractory GAVE in a 71-year-old female patient after 5 years of conservative management, is presented. The patient underwent successful laparoscopic distal gastrectomy and gastrojejunostomy with resolution of symptomatic anemia and melena. Clinical findings, diagnosis, etiology, and treatment of GAVE are reviewed here, with discussion of safety and efficacy of laparoscopic gastric resection for its treatment.