Gastric Antral Vascular Ectasia Patients Research Articles

Influences of etiology and endoscopic appearance on the long-term outcomes of gastric antral vascular ectasia.

BACKGROUNDGastric 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.AIMTo compare the clinical features and long-term outcomes of GAVE according to endoscopic patterns and etiologies.METHODSThe 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).RESULTSAll 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 (P < 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% vs 4/16, 25.0%; P = 0.019), and more common in the striped group than in the punctate group (5/6, 83.3% vs 5/17, 29.4%; P = 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.CONCLUSIONPunctate-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.

Accuracy of virtual chromoendoscopy in differentiating gastric antral vascular ectasia from portal hypertensive gastropathy: A proof of concept study

BACKGROUNDAccurate detection of gastric antral vascular ectasia (GAVE) is critical for proper management of cirrhosis-related gastrointestinal bleeding. However, endoscopic diagnosis of GAVE can be challenging when GAVE overlaps with severe portal hypertensive gastropathy (PHG).AIMTo determine the added diagnostic value of virtual chromoendoscopy to high definition white light for real-time endoscopic diagnosis of GAVE and PHG.METHODSWe developed an I-scan virtual chromoendoscopy criteria for diagnosis of GAVE and PHG. We tested our criteria in a cross-sectional cohort of cirrhotic adults with GAVE and PHG when high-definition white light endoscopy (HDWLE) diagnosis was in doubt. We then compared the accuracy of I-scan vs HDWLE alone to histology.RESULTSTwenty-three patients were included in this study (65.2% Caucasians and 60.9% males). Chronic hepatitis C was the predominant cause of cirrhosis (43.5%) and seven adults (30.4%) had confirmed GAVE on histology. I-scan had higher sensitivity (100% vs 85.7%) and specificity (75% vs 62.5%) in diagnosing GAVE compared to HDWLE. This translates into a higher, albeit not statistically significant, accuracy of I-scan in detecting GAVE compared to HDWLE alone (82% vs 70%). I-scan was less likely to lead to an accurate diagnosis of GAVE in patients on dialysis (P < 0.05) and in patients with elevated creatinine (P < 0.05). I-scan had similar accuracy to HDWLE in detecting PHG.CONCLUSIONThis pilot work supports that virtual chromoendoscopy may obviate the need for biopsies when the presence of GAVE is in doubt. Larger studies are needed to assess the impact of virtual chromoendoscopy on success of endoscopic therapy for GAVE.

Long-term follow-up in patients with gastric antral vascular ectasia (GAVE) after treatment with endoscopic band ligation (EBL).

Background and study aims Gastric antral vascular ectasia (GAVE) is a capillary-type vascular malformation of the gastric antrum, usually diagnosed endoscopically in patients presenting with iron deficiency anemia or gastrointestinal bleeding. While there is established evidence for treatment with thermal modalities, such as argon plasma coagulation (APC) therapy, more recent studies have shown endoscopic band ligation (EBL) to be safe and effective in achieving remission. Our study aimed to evaluate long-term outcomes of patients with GAVE who underwent EBL at our institution. Patients and methods We retrospectively reviewed data from 33 patients with GAVE who underwent esophagogastroduodenoscopy and EBL between September 2012 and July 2017 within our institution, looking primarily at clinical response, recurrence, and blood transfusion requirements. Results Clinical response was achieved in 27 patients (81.8%). Among responders, recurrence-free survival decreased with time from 88 % at 1 year to 44 % at 2 years. Thirteen patients (48.1 %) had recurrence of GAVE at a mean time of 18.2 months (range 4.7 – 51.8). The only predictor of recurrence was greater number of pre-procedure blood transfusions. Conclusion This is the first study to evaluate long-term response and recurrence in patients with GAVE after treatment with EBL and predictors of clinical response after initial endoscopic therapy have been identified. While we were able to demonstrate excellent remission achievement rates in our GAVE patients who had undergone EBL, close clinical follow-up is clearly required as almost 50 % will have recurrence at around 18 months.

Endoscopic band ligation versus argon plasma coagulation in management of bleeding from gastric antral vascular ectasia in patients with portal hypertension

Background Gastric antral vascular ectasia (GAVE) may cause recurrent hemorrhage, and thus, chronic anemia, in patients with portal hypertension. Treatment with argon plasma coagulation (APC) is an effective and safe method in adults but requires multiple sessions of endoscopic therapy. Endoscopic band ligation (EBL) was found to be a good alternative for APC as a treatment for GAVE, especially in refractory cases. The aim of this prospective study was to evaluate the safety and efficacy of EBL, as compared with APC, in treating nonvariceal upper GI bleeding GAVE in patients with portal hypertension. Patients and methods A total of 40 patients with bleeding from GAVE were prospectively randomized to endoscopic treatment with either EBL or APC, every 4 weeks, until complete obliteration was accomplished. Hemoglobin level was obtained before and after treatment; then they were followed up endoscopically after 6 months, with documentation of the recurrence of the lesion, if that occurred. Results We found that EBL significantly decreased the number of sessions required for complete obliteration of the lesions (1.85 ± 0.81 sessions compared with 4.15 ± 1.22 sessions in the APC group; P Conclusion We concluded that GAVE could be safely and successfully managed by EBL or APC. Our study revealed that EBL is more effective, more time saving, and is comparable in safety to APC, in treating nonvariceal upper GI bleeding GAVE in patients with portal hypertension.

Improvement of iron-deficiency anemia resulting from gastric antral vascular ectasia in patients with systemic sclerosis: cyclophosphamide versus argon plasma coagulation

BackgroundSystemic sclerosis is an autoimmune disease characterized by multisystem affection that could involve the gastrointestinal tract in the form of gastric antral vascular ectasia (GAVE) that might cause iron-deficiency anemia.ObjectiveEvaluation of the outcome and the experience of management of iron deficiency anemia resulting from GAVE in patients with scleroderma using cyclophosphamide therapy compared with argon plasma coagulation (APC).Patients and methodsThis study was conducted over a 2-year period from February 2015 to February 2017. Scleroderma patients with GAVE and iron deficiency anemia were treated with cyclophosphamide (group I) others with APC application to areas with mucosal vascular lesions (group II).ResultsIn total, 14 scleroderma patients with iron deficiency anemia resulting from associated GAVE were enrolled into two groups: group I included seven patients who were treated with cyclophosphamide infusion and group II were exposed to APC in sessions. Patients were followed up at 3 and 6 months; the endpoint was a complete response with improved anemia [hemoglobin (HB) and blood indices], and it was achieved in both groups as we found in group I patients there was a highly significant improvement (P<0.001) in HB, 3 and 6 months after therapy and in group II patients there was a highly significant improvement (P<0.001) in iron level 3 and 6 months, HB 6 months after. On comparing both groups it was clear that there was a significant improvement in group I as regards HB and ferritin levels 3 and 6 months after treatment when compared with group II, and highly significant increase in serum iron level 6 months after treatment in group I when compared with group II.ConclusionWe found that cyclophosphamide and APC are highly efficacious and safe in controlling anemia resulting from scleroderma-associated GAVE. Also, cyclophosphamide is more efficient than APC in improving in those patients.

An Analysis of the Clinical, Laboratory, and Histological Features of Striped, Punctate, and Nodular Gastric Antral Vascular Ectasia.

Gastric antral vascular ectasia (GAVE) commonly presents as linear striped ("watermelon stomach") or punctate phenotypes, to which a newly discovered nodular form was recently added. We performed a retrospective cohort study to detail and compare the clinical and histological characteristics of major GAVE phenotypes. In 136 GAVE patients (tertiary care ambulatory and inpatient, median age 61.3years, 73 men, and 63 women), clinical and laboratory results were recorded, with comorbidities, endoscopy indications, and complications of cirrhosis. In 74 patients, GAVE histopathology was cataloged by a pathologist masked to endoscopy results. Median age 61.3years, 73 men, and 63 women. GAVE phenotypes were: linear striped-62 (46%), punctate-32 (24%), and nodular-41 (30%). Endoscopy was commonly performed for variceal screening in linear striped (45%) and nodular (34%) GAVE and for gastrointestinal bleeding in punctate (41%) and nodular (29%) GAVE, respectively. Of 89 cirrhotic patients, 37.5% each had linear striped or nodular GAVE, 24.7% had punctate forms (p=0.03). Child-Turcotte-Pugh and Model for End-Stage Liver Disease scores were similar among phenotypes. Histologically, reactive epithelial hyperplasia and vascular ectasia were universal; smooth muscle proliferation was more common and consistent (78-86%) than microvascular thrombi (27-59%) and fibrohyalinosis (18-53%), which each varied with phenotype. Nodular GAVE is a gastric mucosal abnormality that is similar to the linear striped and punctate phenotypes, yet has distinct clinical and histological features. Increased awareness of nodular GAVE by endoscopists is needed to avoid its misdiagnosis as nonspecific antral nodules.

Antral mucosal perfusion is not increased in GAVE

ABSTRACTObjectives: Although a common cause of intestinal blood loss, the pathophysiology of gastric antral vascular ectasia (GAVE) is not well understood. We aimed to evaluate gastric antral and body mucosal flow in GAVE patients compared to a control population using laser Doppler flowmetry.Methods: 27 patients with GAVE and 11 control patients without GAVE were evaluated using an endoscopic LDF probe. The probe was placed in the gastric antrum and body in order to calculate standardized mucosal flow rates recorded as perfusion units (PU).Results: Despite its hyperemic appearance and propensity to bleed, antral blood flow was not increased in GAVE: 115.5 PU (IQR: [94.4, 135.9 PU]) in GAVE versus 123.7 PU (IQR: [109.7, 186.5 PU]) in controls. There was a significant gradient between the gastric body and antral blood flow in GAVE (p < 0.001) that was not evident in controls.Conclusion: These results indicate that antral mucosal blood flow is not increased in GAVE despite its grossly hyperemic appearance. A mild but statistically significant gradient was noted between the gastric antrum and body in patients with GAVE compared to controls. The pathophysiological significance of this finding is uncertain.

Gastric Antral Vascular Ectasia and Underlying Microvascular or Vascular Disease: Is There an Association?

Introduction: Gastric antral vascular ectasia (GAVE) is an important cause of chronic gastrointestinal (GI) bleeding accounting for 4% of non-variceal upper GI bleeding. It has been classically associated with cirrhosis, chronic kidney disease (CKD), hypothyroidism and autoimmune (AI) disorders. We aim to describe the clinical profile of patients with GAVE without known cirrhosis and to elucidate any associations with concomitant vascular or microvascular disorders. Methods: A retrospective study was conducted that included all patients diagnosed with GAVE without underlying cirrhosis (group 1). GAVE was diagnosed based on endoscopic appearance. An age and sex matched group of patients with cirrhosis and GAVE (group 2) was also included to serve as the control group. Information on demographics and co-morbid conditions like hypertension (HTN), diabetes mellitus I/II (DM), CKD, AI diseases, peripheral arterial disease requiring intervention (PAD), coronary artery disease (CAD), cerebrovascular disease (CVD) and smoking history was collected. Unpaired t-test was used to determine significance. Results: Seventeen patients were included in group 1 (mean age 65.3+15.1 years, women 70.6%) and group 2 (mean age 65.1+6.5 years, women 70.6%) each. Mean BMI was 29.8+6.5 (group 1) and 31.9+5.1 (group 2) respectively (p=0.300). Comparing group 1 vs. group 2, only CAD with a prevalence of 58.8% and 17.6%, respectively [p-value=0.0042] was statistically significant. PAD with a prevalence of was 17.6% (group 1) and 0% (group 2) [p-value=0.073] approached significance. Other conditions like HTN, DM, CVD, AI diseases, CKD and smoking history were not statistically significant (Table 1).Table 1Conclusion: In our small cohort of patients with GAVE, we found CAD was strongly associated with GAVE in patients without cirrhosis when compared to those with cirrhosis, while PAD approached statistical significance. We are limited by the small sample, which likely lowered the power of our study. Further large sample sized studies could help elucidate the association between underlying vascular disease and GAVE.

Clinical Characterization of Gastric Antral Vascular Ectasia: A Potential Manifestation of the Metabolic Syndrome

Background and ObjectivesGastric antral vascular ectasia is a relatively common endoscopic finding. Past studies have shown an association of gastric antral vascular ectasia with cirrhosis and autoimmune disorders. We aimed to re-examine these associations and to investigate a possible association of gastric antral vascular ectasia with features of the metabolic syndrome. MethodsThere were 135 patients with a diagnosis of gastric antral vascular ectasia from years 1995-2013 seen at the University of Virginia who were identified from a clinical data repository and age and sex matched to a cohort of patients without gastric antral vascular ectasia undergoing endoscopy within the same time frame as the index cases. The groups were compared for comorbidities including autoimmune disease, cirrhosis, vascular disease, body mass index (BMI), diabetes mellitus, and cirrhosis due to nonalcoholic steatohepatitis. ResultsSixty-four percent of gastric antral vascular ectasia patients were cirrhotic, compared with 14% of controls (P <.001). Vascular disease was more common in the gastric antral vascular ectasia cohort (57% vs 36%; P <.001). The mean BMI was also higher in the gastric antral vascular ectasia cohort (33.7 kg/m2 vs 28.8 kg/m2; P <.001). Diabetes mellitus and nonalcoholic steatohepatitis cirrhosis were more frequently observed in gastric antral vascular ectasia subjects (64% vs 29% in controls [P <.001] and 28% vs 2% [P <.001], respectively). There was not an increased prevalence of autoimmune disease in gastric antral vascular ectasia patients vs controls (15% vs 13%; P = .861). ConclusionThese results confirm the association of gastric antral vascular ectasia with underlying cirrhosis and revealed a significant correlation of gastric antral vascular ectasia with features of metabolic syndrome such as diabetes, BMI, vascular disease, and nonalcoholic steatohepatitis cirrhosis. The pathophysiology of gastric antral vascular ectasia remains uncertain, but we speculate that it may be a manifestation of the metabolic syndrome.

Patients with Gastric Antral Vascular Ectasia (GAVE) Are at a Higher Risk of Gastrointestinal Bleeding in the Absence of Cirrhosis.

Background and Aims: Gastric antral vascular ectasia (GAVE) is commonly found in patients with cirrhosis, but it is also associated with other diseases in the absence of cirrhosis. Whether GAVE confers a different severity of gastrointestinal (GI) bleeding between patients with and without cirrhosis remains unknown. We aim to examine whether there is a difference in clinically significant GI bleeding due to GAVE in patients with or without cirrhosis. Methods: This is a retrospective case-control study of patients who were diagnosed with GAVE between January 2000 and June 2014. Patients were categorized into cirrhosis and noncirrhosis groups, and those with an additional GI bleeding source were excluded. Univariate comparisons and multivariable models were constructed using logistic regression. Results: In total, 110 patients diagnosed with GAVE on esophagogastroduodenoscopy (EGD) were included in our analysis; 84 patients had cirrhosis (76.4%) and 26 (23.6%) did not. Active GI bleeding was more prevalent in patients without cirrhosis (63.4% vs. 32.1%, p=0.003) despite similar indications for EGD, and endoscopic treatment with argon plasma coagulation (APC) was required more often in this group, approaching statistical significance (27% vs. 10.7%, p=0.056). There was no difference in bleeding severity, as evidenced by similar re-bleeding rates, surgery, or death attributed to uncontrolled bleeding. The strongest independent risk factor for GI bleeding was the absence of cirrhosis (odds ratio (OR): 5.151 (95% confidence interval (CI): 1.08-24.48, p=0.039). Conclusions: Patients with GAVE in the absence of cirrhosis are at higher risk for active GI bleeding and require more frequent endoscopic treatment than similar patients with cirrhosis. It may be worthwhile to treat GAVE in this population even in the absence of active bleeding.

An Atypical Appearance of Gastric Antral Vascular Ectasia (GAVE) with Complete Resolution after Liver Transplant

Purpose: Gastric antral vascular ectasia (GAVE) is a rare cause of upper gastrointestinal bleeding in end-stage liver patients being considered for liver transplant, and can be difficult to recognize. The correct diagnosis has therapeutic implications for successful treatment of bleeding. A 56-yearold male with alcoholic cirrhosis, complicated by ascites and non-bleeding gastroesophageal varices, presented for liver transplant evaluation. The most severe manifestation of his cirrhosis was chronic blood loss anemia requiring transfusion of two units of blood every two weeks. He had melenic stools and required frequent hospital admissions for anemia. A pre-transplant esophagogastroduodenoscopy revealed gastroesophageal varices without stigmata of recent bleeding, diffuse GAVE in the antrum with some areas of active oozing, and a fleshy, nodular mass in the second part of the duodenum with thick folds of oozing, friable mucosa. The most active areas of bleeding were over this mass-like lesion. A biopsy of the mass showed vascular ectasias with thombosis, consistent with nodular GAVE in the duodenum. The patient had treatment with serial argon plasma coagulation, however still remained transfusiondependent. Six months after the diagnosis of GAVE, he underwent an orthotopic liver transplantation. After the immediate post-operative period, he was no longer transfusion dependent. An esophagogastroduodenoscopy performed a year after his transplant showed complete resolution of his antral GAVE, as well as complete resolution of his nodular, duodenal GAVE. The endoscopic appearances of GAVE have been described in literature as puctate-type vascular ectasias, which are more strongly associated with cirrhosis, as well as striped, erythematous lesions arranged radially from the pylorus, more commonly termed “watermelon stomach.” Both these presentations share the same histologic findings of mucosal capillary dilations, fibrin thrombi, and fibromusclar hyperplasia. In our patient, we present an atypical, nodular presentation of GAVE in the duodenum. Our case also highlights the resolution of GAVE in patients with liver disease after liver transplantation. The recognition of GAVE is necessary for successful treatment. GAVE-induced bleeding can be treated with thermal ablation or estrogen, and can be cured with liver transplantation; however, it has not been shown to be responsive to treatments with reduction in portal pressure.

Comparison of argon plasma coagulation in management of upper gastrointestinal angiodysplasia and gastric antral vascular ectasia hemorrhage

BackgroundVascular ectasias, including gastric antral vascular ectasia (GAVE) and angiodysplasia, are increasingly recognized as important sources of gastrointestinal bleeding. This study investigated and compared the efficacies and outcomes of treatment of upper gastrointestinal (UGI) angiodysplasia and GAVE hemorrhage by endoscopic argon plasma coagulation (APC).MethodsFrom January 2006 to December 2009, 46 patients diagnosed with upper GI bleeding caused by angiodysplasia or GAVE at a tertiary hospital were recruited into this study. They included 26 males and 20 females with an average age of 65.6 years (range, 45–90 years). All patients underwent APC for hemostasis during an endoscopic procedure. Parameters such as underlying co-morbidities, number of endoscopic treatment sessions, recurrent bleeding, and clinical outcomes during follow-up were analyzed.ResultsThe 46 patients with UGI vascular ectasia hemorrhage included 27 patients with angiodysplasia and 19 with GAVE. The patients with angiodysplasia were older than those with GAVE (71.6 ± 10.2 years versus 61.8 ± 11.9 years, P = 0.005). More GAVE patients than angiodysplasia patients had co-existing liver cirrhosis (63.2% versus 25.9%, P = 0.012). The patients with GAVE had a higher rate of recurrent bleeding (78.9% versus 7.4%, P < 0.001) and required more treatment sessions to achieve complete hemostasis (2.4 ± 1.4 versus 1.1 ± 0.1, P < 0.001) than those with angiodysplasia. Univariate analysis demonstrated that age greater than 60 years (odds ratio (OR) = 8.929, P = 0.003), GAVE (OR = 0.021, P < 0.001), and previous radiation therapy (OR = 11.667, P = 0.032) were associated with higher rates of recurrent bleeding. Further multivariate analysis revealed that GAVE was the only independent risk factor for recurrent bleeding after APC treatment (OR = 0.027, P < 0.001).ConclusionEndoscopic hemostasis with APC is a safe treatment modality for both angiodysplasia and vascular ectasia bleeding. The efficacy of APC treatment is greater for angiodysplasia than for vascular ectasia bleeding. GAVE patients have a higher recurrent bleeding rate and may require multiple treatment sessions for sustained hemostasis.

Gastric Antral Vascular Ectasia (GAVE) Presenting as an Unusual Cause of Occult Bleeding: A Case Report

Purpose: Gastric antral vascular ectasia (GAVE) syndrome is rare and uncommon cause of occult gastrointestinal bleeding. Characteristic endoscopic appearance of ‘watermelon stripes' earns it the name watermelon stomach. GAVE patients often present with insidious onset of weakness, fatigue secondary to iron deficiency anemia, resulting from occult blood loss. Elderly people are affected mostly and the diagnosis is often missed. Pathogenesis is unknown although this could be a variant of Heyde's syndrome in which gastrointestinal angiodysplasias are associated with aortic valvular disease. Diagnosis is based on clinical history, endoscopic appearance and histological changes. Prompt recognition and treatment with either heater probe, electrocoagulation or argon plasma coagulation result in complete recovery and decreased morbidity and mortality. We present a case of an elderly man with aortic stenosis and multiple other medical problems who presented with fatigue, weakness and severe anemia secondary to chronic blood loss who was diagnosed with GAVE syndrome and prompt diagnosis and treatment resulted in complete recovery.

Endoscopic Argon Plasma Coagulation for the Treatment of Gastric Antral Vascular Ectasia-Related Bleeding in Patients with Liver Cirrhosis

Background and Aim: Gastric antral vascular ectasia (GAVE) is a cause of bleeding in patients with liver cirrhosis. Argon plasma coagulation (APC) is the most used endoscopic treatment for GAVE-related bleeding. Treatment failures have been described in patients with haemorrhagic diathesis; post-procedure complications include haemorrhages and septicaemia. The aim of the study was to evaluate efficacy and safety of APC treatment of GAVE-related bleeding in patients with liver cirrhosis. Methods: Patients included were suffering from GAVE-related bleeding and liver cirrhosis. APC treatment was performed until eradication. Resolution of transfusion-dependent anaemia and evaluation of complications were the primary outcomes. Results: 20 patients (16 Child C and 4 Child B) were enrolled and prospectively followed for a mean period of 28 months. GAVE eradication was achieved in all patients after a median of 3 sessions (range 1–10). Resolution of anaemia was achieved in 18 patients. Six patients had relapse of GAVE after a mean of 7.7 months, successfully retreated by APC. Hyperplastic polyps developed in 3 patients causing active bleeding in 2 cases. Five patients had liver transplants and 1 had a relapse of GAVE after transplantation. Conclusion: APC is an effective and safe endoscopic treatment for GAVE in patients with liver cirrhosis.

Prevalence and Natural History of Gastric Antral Vascular Ectasia in Patients Undergoing Orthotopic Liver Transplantation

To describe the prevalence and natural history of gastric antral vascular ectasia (GAVE) in patients with end-stage liver disease undergoing orthotopic liver transplantation (OLT). GAVE is a well-recognized cause of gastrointestinal hemorrhage. Although 30% of patients with GAVE have liver disease, the prevalence of GAVE in patients with cirrhosis is not known. We reviewed clinical records of patients who underwent OLT at our institution from February 1, 1998 to June 2003. Demographic and clinical details were recorded with attention to findings during upper endoscopy before and after OLT. A total of 597 patients underwent OLT, and 345 were evaluated preoperatively with esophagogastroduodenoscopy (EGD). Eight (2.3%) were found to have GAVE before OLT. Three of these eight underwent EGD after OLT, and GAVE was absent in all three. None of the patients with GAVE experienced gastrointestinal bleeding postoperatively. GAVE was present in nearly 1 in 40 patients with end-stage liver disease who underwent EGD before OLT at our institution and appears to resolve after transplant. These findings are consistent with a previous report documenting resolution of GAVE after OLT.