Sa1641 Endoscopic Treatments for Gastric Antral Vascular Ectasia Associated With Chronic Liver Disease

Abstract

upper gastrointestinal endoscopy in China. However, the endoscopic diagnosis and appropriate patient management have not been thoroughly investigated. We aimed to retrospectively review our experience on HP with emphasis on diagnosis and management. Patients and Methods: We searched the medical and pathologic records for the final diagnosis of HP over the period of January 2004 through August 2010 at the Nanjing Drum Tower Hospital in China. Clinical, pathological, and surgical therapy data on cases with HP were reviewed. Results: We identified 30 consecutive patients with HP. Patients’ median age was 43 (range: 15-67) with a slight female (53%) predominance. As a submucosal lesion, HP was found predominantly in the stomach (53%), and some in the duodenum (10%), the jejunum (23%), the lesser omentum (7%), and the mesenterium (7%). Of the 30, 43% were detected incidentally during other operative procedures, 23% were revealed endoscopically with a clinical misdiagnosis of different diseases, and the remaining 33% diagnosed correctly at endoscopy. Before 2007, almost all (10/11, 91%) were found incidentally as a palpable submucosal mass during open surgical procedures for other conditions. However, in the 19 cases diagnosed after January 2007, only 3 (16%) were incidental findings and the majority (84%) were endoscopically identified, either incorrectly or correctlydiagnosed, which was significantly higher than that identified before 2007 (84% vs. 9%, p 0.05). Among the 7 mis-diagnosed HP lesions, 4 were as GISTs, 2 as gastric polyps, and 1 as a tumor of the Vater’s papilla with malignant potential. In the 17 cases recognized endoscopically, the patients presented with symptoms including, in the descending order, abdominal distention (65%) or pain (29%), weakness (18%), melena (6%), and jaundice (6%), nausea and vomiting (6%), anorexia (6%), and weight loss (6%). HP in the majority cases (82%) was located in the stomach, a few in the duodenum (12%) or the proximal jejunum (6%). The therapeutic management of these 17 cases consisted of ligation-assisted endoscopic mucosal resections (59%), laparoscopic or open local resections (24%), laparoscopy or open distal gastrectomy (12%), and open pancreaticoduodenectomy (6%). Conclusion: HP can be detected more frequently at endoscopy in the upper gastrointestinal tract with the stomach as the predominant site. The endoscopist’s awareness of and understanding of the non-specific clinical presentations and endoscopic characteristics of HP is essential for correct diagnosis and appropriate patient management.