Vascular Ectasia Research Articles

Cutaneous Manifestations of Scleroderma

ABSTRACT Scleroderma is a rare, female predominant clinically heterogenous, autoimmune condition characterized by the presence of autoantibodies, vascular abnormalities, and fibrosis. Skin thickening as a result of fibrosis is a hallmark clinical finding, and the extent of this skin thickening further classifies clinical subsets of scleroderma. Organ systems affected may include pulmonary (interstitial lung disease, pulmonary arterial hypertension), renal (scleroderma renal crisis), gastrointestinal (dysmotility, reflux esophagitis, gastric antral vascular ectasia), cardiac (arrhythmias, cardiac fibrosis), and musculoskeletal (arthritis, contractures). Raynaud phenomenon and telangiectasis occur as a result of vascular involvement. Diagnostic workup requires a thorough history and physical examination, supplemented by autoantibody testing. No single therapeutic agent is indicated to treat all manifestations of scleroderma. Rather, system- or organ-based treatment is indicated. Not only are skin manifestations often the presenting feature of scleroderma, progressive skin changes carry prognostic implications, underscoring the value of dermatology insight for early diagnosis suspicion, referral to rheumatology, and timely management.

Spray coagulation as an alternative to argon plasma coagulation for bleeding portal hypertensive gastropathy

Spray coagulation as an alternative to argon plasma coagulation for bleeding portal hypertensive gastropathy

Tranexamic acid may be a useful pharmacotherapy for endoscopically resistant small bowel angiodysplasia.

Small bowel angiodysplasia (SBAD) is reported to account for nearly 50% of cases of small bowel bleeding. When SBAD occurs frequently, it is difficult to treat all the angiodysplasias endoscopically, and gastrointestinal bleeding often recurs. Hormone therapy, somatostatin analogs, thalidomide and vascular endothelial growth factor (VEGF)-neutralizing antibodies have been reported to reduce gastrointestinal angiodysplasia (GIAD) bleeding. However, there is no strong evidence to recommend them. Also, there are no guidelines for their use. Hereditary hemorrhagic telangiectasia (HHT) is a hereditary disease caused by abnormalities in VEGF, resulting in multiple GIADs. A treatment guideline has been created for GIAD in HHT, and the use of tranexamic acid, an antifibrinolytic agent, is the first recommendation pharmacotherapy for GIAD with gastrointestinal bleeding that is difficult to treat endoscopically. It has been reported that fibrinolysis is accelerated in GIAD patients who are not HHT, similar to HHT patients. The use of tranexamic acid for gastric antral vascular ectasia in GIAD has been reported to be useful. However, there are very few reports of its use for SBAD. There are concerns with tranexamic acid use regarding the development of thrombosis/embolism, but there are few reports of such side effects. Future clinical trials including tranexamic acid for SBAD are desired.

Erythropoietin resistance-secondary to watermelon stomach: a forgotten story in chronic kidney disease patients.

Watermelon stomach, also known as gastric antral vascular ectasia (GAVE), is a rarely seen cause of acute upper gastrointestinal bleeding or chronic iron deficient anemia, revealed when gastroscopy is performed. GAVE affects predominantly women of advanced aged and is usually associated with certain underlying co-morbidities including liver cirrhosis, autoimmune diseases and chronic kidney disease. Based on the above, we report the case of a 75-year old woman under hemodialysis for six consecutive years due to end-stage renal disease attributable to hypertensive nephrosclerosis. The patient also suffered from chronic ischemic heart disease, severe peripheral artery disease and an unidentified connective tissue-disease characterized by high levels of anti-nuclear antibodies and clinical symptoms restrained in flares of non-erosive polyarthritis. Six months prior, she developed hyporesponsiveness to recombinant human erythropoietin (rEPO) due to iron deficiency despite the administration of the appropriate dose of intravenous iron as well as the exclusion of other co-existing causes of resistance, namely inadequate hemodialysis, inflammation, malnutrition, severe hyperparathyroidism and underlying hematologic disorders. Surprisingly, the patient experienced a sudden episode of severe upper gastrointestinal bleeding characterized by hemodynamic instability, hemoglobin fall and melena that required blood transfusions. Once hemodynamic stabilization was achieved, an upper endoscopic exam was performed showing the pathognomonic extensive vascular ectasias and patchy erythematosus lesions at the distal antrum. Thus, GAVE should be considered in the differential diagnosis of chronic kidney disease patients who present not only with acute blood loss but also with resistance to rEPO due to inadequate iron stores.

Repeated endoscopic treatment of gastric antral vascular ectasia.

GAVE is a relatively rare acquired vascular disease. The most common treatment for GAVE is endoscopic therapy. Argon plasma coagulation（APC） is usually the first-line choice for endoscopic GAVE treatment, but its recurrence rate is high and often requires multiple repeated treatments. In this case, the GAVE patient recurred after two APC treatments. The results suggest that APC-treated patients with GAVE are prone to relapse. In conclusion, clinicians should regularly follow up patients who received APC treatment.

A Case of Gastric Antral Vascular Ectasia that Underwent Laparoscopic Distal Gastrectomy

A Case of Gastric Antral Vascular Ectasia that Underwent Laparoscopic Distal Gastrectomy

Early Gastric Cancer Arising From Hyperplastic Polyps After Argon Plasma Coagulation for Gastric Vascular Ectasia

Early Gastric Cancer Arising From Hyperplastic Polyps After Argon Plasma Coagulation for Gastric Vascular Ectasia

Gastric Antral Vascular Ectasia as a Reversible Cause of Upper Gastrointestinal Bleeding in the Oldest Old

Abstract Gastric antral vascular ectasia (GAVE) is a rare condition which accounts for 4% of the nonvariceal acute upper gastrointestinal (GI) bleeding. The mean age of diagnosis is 70 years. This condition is often misdiagnosed as hemorrhagic antral gastritis or portal hypertensive gastropathy. In this case report, we report the oldest person to date in the South Asian population with upper GI bleeding caused by GAVE. An 87-year-old, female, known case of chronic obstructive pulmonary disorder and systemic hypertension under medication for 2 years, current smoker, previous alcohol consumer presented to the emergency department with complaints of hematemesis, melena, and easy fatigability. On general physical examination, pallor was present. A provisional diagnosis of chronic anemia secondary to upper GI bleeding was made. Upper GI endoscopy revealed ectatic vessels radiating from the gastric antrum which was diagnosed as GAVE. Blood transfusion was done, and three sessions of argon plasma coagulation were done. In the oldest old, GAVE is an overlooked cause of GI bleeding and persistent severe anemia. It might also mimic the signs and symptoms of GI malignancy. However, the frail older adult and their caretakers must be counseled about its reversibility, good prognosis, and nonmalignant nature. Simple intervention can improve the quality of life in the frail oldest old.

Start Early and See Inflammatory; Late, Nothing Save RAVE: How to Appreciate Radiation Proctitis as a Continuum.

It has been recently proposed to change the nomenclature of "chronic radiation proctitis" (CRP) to "radiation-associated vascular ectasia" on the basis that signs of inflammation are rarely observed. We herein present data supporting the idea that inflammation is a critical step that initiates the process that culminates in the characteristic changes of CRP. In support of inflammation in the pathogenesis of CRP, we review the pertinent literature and publish our new results, including the role of amifostine treatment and proinflammatory factors (p38 MAP kinase, VEGF, and CEACAM1). Immunohistochemistry from anterior rectal wall biopsies obtained in a prospective pilot study demonstrates that expression of VEGF and the downstream vascular effector CEACAM1 were elevated before radiotherapy and declined with time. We also show that MAP Kinase p38 expression usually precede the radiation. Fibrosis scores increase from baseline at 9 and 18 months, while vascular scores decrease at 18 months. The proposed new nomenclature should be held in obeyance until more supportive data are presented. Possibly, the best way to view CRP is as a continuum that may take one of three forms, inflammation-predominant, vasculopathy-predominant, or mixed.

The Use of Thalidomide in Severe Refractory Anaemia Due to Gastric Antral Vascular Ectasia (GAVE) in Cirrhosis in a resource constrained set up-A case series from South India

The Use of Thalidomide in Severe Refractory Anaemia Due to Gastric Antral Vascular Ectasia (GAVE) in Cirrhosis in a resource constrained set up-A case series from South India

Patterns of placental injury in various types of fetal congenital heart disease.

Fetal blood circulation may be modified in congenital heart disease (CHD). This retrospective analysis was performed to study whether the type of CHD is associated with specific placental pathology. Three types of CHD based on presumed proportion of placental and systemic blood distribution in fetal circulation were analyzed: Group 1: 89 cases with low placental blood content (hypoplastic left heart syndrome, transposition of great arteries, coarctation of aorta), Group 2: 71 placentas with intermediate placental and systemic blood content due to increased intracardiac blood mixing (tetralogy of Fallot, truncus arteriosus, double inlet/outlet ventricle), and Group 3: 24 placentas with high placental blood content (tricuspid or pulmonary atresia, Ebstein anomaly). Frequencies of 27 independent clinical and 47 placental phenotypes of 184 placentas in those three groups were statistically compared. The most advanced gestational age at delivery, and large vessel (global) fetal vascular malperfusion (FVM) were most common in Group 1, while macerated stillbirths, neonatal mortality, abnormal amniotic fluid volume (oligohydramnios or polyhydramnios), other congenital anomalies, distal villous lesions of FVM, placental edema and amnion nodosum were most common in Groups 2 and 3, although the frequencies of placental lesions were statistically not significant. Left heart obstructive lesions potentially associated with brain maldevelopment show increase in lesions of global FVM (in aggregate and individually fetal vascular ectasia, stem vessel obliteration and intramural fibrin deposition) as may be seen in umbilical cord compromise. CHD with increased intracardiac blood mixing or with right heart defects is associated with average preterm gestational age at delivery and placental lesions of distal villous FVM, villous edema and amnion nodosum.

The Arterial Pattern of the Upper Nasal Septum (S-Point) and Potential Role in Severe Epistaxis.

The previously described S-point, corresponds to the medial projection of the middle turbinate axilla in the superior nasal septum and has been identified as a common source of severe epistaxis. The objective is to define the anatomical patterns of vascularization of the S-point area that could explain its clinical relevance. Thirty-three nasal septums of latex-injected formalin-embalmed and fresh human cadaveric heads were dissected to analyze the arterial arrangement of the S-point area. Measurements and patterns of vascularization were described. The S-point area, was consistently surrounded by a single or multiple arterial anastomotic arches consistently formed superiorly by the anterior ethmoidal and posterior ethmoidal artery branches, and inferiorly by the posterior septal artery. The caliber of the arterial arches was typically larger than the caliber of the arterial branches supplying them. A single arch was present in 36.3% of septums, and multiple arches in 63.6%. The mean distance from the S-point to the anterior limit of the arch was 9 mm, to the posterior arch when the present was 3 mm, to the superior limit 6 mm, to the inferior limit 6 mm, and to the nasal roof was 10 mm. This study demonstrates the dense arterial configuration of the S point area, which is characterized by a single or multiple vascular arches of greater caliber than the branches of origin. This finding could explain why the S-point area is a frequent source of epistaxis, and guide its surgical cauterization when an obvious vascular ectasia is not visualized. N/A Laryngoscope, 133:2075-2080, 2023.

Bevacizumab in combination with octreotide rescues a patient with liver cirrhosis, GAVE syndrome and refractory hemorrhage - a case report.

Gastric antral vascular ectasia (GAVE) syndrome is a rare but often challenging etiology of upper gastrointestinal bleeding (UGIB).We report on a 60-year-old patient with liver cirrhosis, GAVE syndrome and recurrent and refractory GAVE-related UGIB. During a 5-month hospital stay, the patient required a total of 82 packed red blood cells (pRBCs) and 23 gastroscopies. All endoscopic approaches, including multiple argon plasma coagulation and band ligation sessions, remained unsuccessful. Antrectomy was waived because of the high perioperative mortality risk in Child-Pugh B liver cirrhosis. TIPS insertion also failed to control the bleeding. Only continuous intravenous octreotide infusion slowed the bleeding, but this forced the patient to be hospitalized. After 144 inpatient days, administration of subcutaneous octreotide allowed the patient to be discharged. However, the patient continued to require two pRBCs every 2-3 weeks. Based on recently published data, we treated the patient with bevacizumab (anti-VEGF antibody) off-label at a dose of 7.5 mg/kg body weight every three weeks in nine single doses over six months. Since the first administration, the patient has remained transfusion-free, has not required hospitalization, and leads an active life, working full-time. He remains on octreotide, which has been reduced but not yet discontinued. Additionally, no adverse events were observed.Thus, in patients with liver cirrhosis and refractory GAVE-related hemorrhage, bevacizumab combined with subcutaneous octreotide should be considered as an effective and durable pharmacological treatment option.

Severe Chronic Rectocolitis Associated With a Characteristic Sunflower Magnetic Resonance Imaging Pattern

Severe Chronic Rectocolitis Associated With a Characteristic Sunflower Magnetic Resonance Imaging Pattern

S2692 Abscess-Enteric Fistula of Failed Kidney Transplant Presenting With Gastrointestinal Bleeding

Introduction: Lower gastrointestinal (GI) bleeding is a common occurrence, with the vast majority of cases being due to diverticula, vascular ectasias, cancers, and hemorrhoids. In rare cases, a large vessel can form a fistula with the GI tract, causing bleeding. We present a case where an abscess surrounding a failed transplant kidney eroded into the external iliac vein and presented as a slow lower GI bleed. Case Description/Methods: A 65-year-old man with a failed renal transplant and known colovesicular fistula presented with hypotension. Labs showed a significant leukocytosis, an elevated lactate, and a hemoglobin of 6.3 g/dL. He was started on broad spectrum antibiotics, and then developed intermittent episodes of small-volume bright red blood per rectum. The patient had an upper endoscopy and colonoscopy one month prior for GI bleeding which had not identified a source. Computed tomography angiography of the abdomen and pelvis revealed a fistulous communication between the sigmoid colon and a multiloculated right lower quadrant collection (Figure). The collection encased the transplanted kidney and right iliac vasculature. Extraluminal extravasation of intra-arterial contrast was noted, concerning for either active arterial bleed or pseudoaneurysm. The patient underwent emergent exploratory laparotomy which revealed a necrotic transplant kidney densely adhered to the surrounding colon and a right external iliac artery pseudoaneurysm. Bleeding was noted from a defect in the right external iliac vein. The kidney was removed, the pseudoaneurysm was stented, and the vein defect was oversewn. Unfortunately, the patient had a complicated post operative course and died. Discussion: In patients with evidence of small-volume rectal bleeding but a clinical picture concerning for a more significant bleed, cross-sectional imaging can be necessary to make the appropriate diagnosis. In this case, imaging identified the abscess-enteric fistula, and laparoscopy revealed that the bleeding was due to a defect in the iliac vein. Abscess-enteric fistulas are associated with post-surgical states or small localized perforations. This patient likely developed a microperforation that infected the failed transplant kidney, creating an abscess which eroded into the iliac vein. GI bleeding was only intermittent and a source was not identified on prior luminal imaging, possibly due to the small size of the fistula tract. This pathology is unfortunately not amenable to endoscopic intervention and often requires surgery.Figure 1.: Computed tomography angiography of the abdomen and pelvis with a multiloculated right lower quadrant collection encasing a transplanted kidney and right iliac vasculature.

S2093 Painless Voluminous Rectal Bleeding: It’s Not Always a “Tic”: A Case of a Recto-Sigmoid Hemangioma

Introduction: Hemangiomas are known as benign vascular tumors and may present as multiple or solitary lesions. Very few cases of colonic hemangiomas have been reported in literature. We present a case of rectal bleeding leading to a finding of recto-sigmoid hemangioma. Case Description/Methods: A 31-year-old female with no past medical history presented to the ED with complaints of bright red blood per rectum (BRBPR). She admitted to having 4 days of blood clots associated with bowel movements, in addition to diffuse lower abdominal pain which has occurred intermittently and progressively worsened for the past 2 years. In Cuba, she was told she had a rectal tumor which was “inoperable”. Lab work on admission was significant for iron deficiency anemia. CT of the abdomen and pelvis with oral and IV contrast revealed findings consistent with active gastrointestinal (GI) bleed in the ascending colon, as well as a 2.5 cm pelvic mass. However, an IR arteriogram revealed a large segment of angiodysplasia in the ascending colon but no evidence of active GI bleed. Transvaginal ultrasound ruled out an adnexal mass. Sigmoidoscopy revealed a large recto-sigmoid mass suspicious for an hemangioma as well as surrounding vascular ectasias. Carefully taken biopsies revealed a benign rectal hemangioma. Ultimately, the patient was stabilized and discharged, with follow-up outpatient with surgical oncology due to the extent of her disease (Figure 1). Discussion: Colonic hemangiomas are extremely rare benign vascular lesions of the GI tract. Often located in the recto-sigmoid, they may be discovered during workup for recurrent painless rectal bleed and rarely presenting as life-threatening bleeding. Large cavernous hemangiomas may be associated with Kasabach-Merritt syndrome, hemolytic anemia, thrombosis and bowel ischemia. Studies reveal that it may take on average up to 19 years before a proper diagnosis is established. There are few reported cases of local invasion to surrounding structures such as bladder and uterus. Despite being incidentally found in colonoscopy, insufflation may flatten these lesions which may be also misinterpreted as proctitis. Imaging studies such as MRI, CT and rectal EUS are helpful in determining the diagnosis. Sclerotherapy, angiographic embolization and ligation of mesenteric vessels may be attempted for small lesions. Surgical resection, if possible, is generally the treatment of choice for more extensive lesions. Due to its mimicking presentation of common GI diseases, hemangiomas risk being overlooked.Figure 1.: Extensive recto-sigmoid hemangioma with associated vascular ectasias.

S2804 Refractory Bleeding From Nodular Gastric Antral Vascular Ectasia (GAVE): Is Combination Therapy of Sclerotherapy and Band Ligation the Solution?

Introduction: Gastric antral vascular ectasia (GAVE) is a rare condition that presents in the distal stomach as dilated longitudinal columns of blood vessels prone to bleeding. Nodular GAVE is an even rarer variant and is often refractory to standard therapy for GAVE. Endoscopic treatment options widely varies and include rubber band ligation, radiofrequency ablation (RFA), argon plasma coagulation (APC), and resection with hot snare. We present a case study of successful treatment of nodular GAVE of a patient who has been refractory to repeated APC with combination therapy of band ligation and sclerotherapy. Case Description/Methods: 63-year-old female with history of alcoholic cirrhosis and pancreatitis who has had persistent iron deficiency anemia thought secondary to chronic blood loss requiring constant transfusions. Initial EGD was performed at age of 60 with evidence of small grade I esophageal varices, portal hypertensive gastropathy, and innumerable gastric polyps in the gastric body and antrum that on biopsy was consistent with nodular GAVE. She then underwent 5 repeat EGDs over a span of 6 months with a combination RFA, APC, snare resection followed by hemostatic clipping, and banding, with continued recurrence of nodular GAVE and transfusion dependent anemia, with total of 17 units of packed red blood cell (pRBC) transfusions required over the same 6 month period. On her seventh EGD, she then underwent combination therapy of sclerotherapy (1% sodium tetradecyl sulfate (STS), 20mL total), which were injected at the base of the nodular areas, along with placement of 12 bands. Her transfusion requirements subsequently subsided after the initial sclerotherapy and band ligation combination session, and the patient received additional 6 EGD sessions with repeat combination therapy over the next 12 months, with notable visual improvement endoscopically subsequent to 2 sclerotherapy plus banding sessions. She only required a total of 3 units of pRBC transfusion over the same period. (Figure) Discussion: We described the first known case of combination sclerotherapy and band ligation therapy for treatment of refractory nodular GAVE. The treatment resulted in significant reduction in transfusion requirements with concomitant improvement of the appearance of nodular GAVE even after just 2 sessions, and may be particularly useful in patients who have failed more conventional treatments. Additional studies will need to be performed to determine the safety and efficacy of this combination treatment modality.Figure 1.: endoscopic images of nodular GAVE before and after serial treatments, along with a timeline of hemoglobin level, transfusions, and endoscopic sessions/therapies over the patient's follow up period of 1.5 years.

S2680 A Case Report of Radiation-Induced Hemorrhagic Gastritis Successfully Treated With Bevacizumab After Failing Endoscopic and Hyperbaric Oxygen Therapies

Introduction: Radiation induced gastritis is an uncommon complication of radiation therapy. Therapies that have been attempted for this pathology include argon plasma coagulation (APC), oral prednisolone, radio-frequency ablation, hyperbaric oxygen, and surgical intervention. We present a case of radiation induced gastritis complicated by transfusion dependent anemia and melena that was successfully treated with Bevacizumab Case Description/Methods: This patient is a 65-year-old male with medical history significant for esophageal adenocarcinoma in 2014 treated with chemoradiation and subsequently esophagectomy. Several years after therapy, he started to report tarry stools, and was found to be anemic with iron studies consistent with severe iron deficiency. He had an esophagogastroduodenoscopy (EGD) that showed severe distal esophagitis. Follow up colonoscopy was unremarkable. He was started on omeprazole and iron infusions, but he needed frequent blood transfusions. He had a repeat EGD that showed diffuse erythema, friability and oozing of the gastric mucosa. This was treated with APC. A biopsy showed a single focus of intravascular fibrin thrombus concerning for radiation induced gastritis. He had transient resolution of his melena, but then had recurrence one month later. He underwent further endoscopies with thermal therapy, which failed to control his bleeding. Hyperbaric oxygen therapy was trialed. After completing multiple sessions, his symptoms persisted. Surgical evaluation was recommended but the patient declined. The patient was then started on anti-angiogenic therapy with Bevacizumab 5mg/kg every 2 weeks and his melena resolved, requiring less transfusions. He stopped taking Bevacizumab two months later as he was scheduled for hernia repair, and he had recurrence of his melena and worsening anemia post-operatively. After being restarted on Bevacizumab, his melena resolved Discussion: Hemorrhagic radiation gastritis is mainly due to mucosal injury and telangiectatic vessels from angiogenesis secondary to endothelial proliferation. Bevacizumab is an anti-vascular endothelial growth factor humanized monoclonal antibody that inhibits angiogenesis. It has been shown to be effective in treatment of hereditary hemorrhagic telangiectasia, gastric antral vascular ectasia, and small bowel angioectasia. It has also been reported to treat hemorrhagic gastritis in a few case studies. Our case demonstrates that Bevacizumab is a promising pharmacologic treatment for radiation induced hemorrhagic gastritis.

S2616 Melena: An Uncommon Presentation of Scurvy

Introduction: Scurvy is the clinical manifestation of vitamin C deficiency and presents with hemorrhage (petechiae, ecchymoses, bleeding mucosa), follicular hyperkeratosis, hemolytic anemia, hypochondriasis, hysteria, depression, and fatigue. Scurvy is a rare diagnosis in industrialized countries; however, it can be seen in alcoholic, elderly, and institutionalized patients or those following fad diets or suffering from malabsorptive disorders. The association of scurvy and GI pathology is rare, but it exists. There have been reported cases of scurvy presenting as GI bleed and even as the initial manifestation of Whipple’s disease. Case Description/Methods: A 71-year-old female with past medical history of systemic lupus erythematosus, carcinoid tumor of the small bowel and abnormal bruising presents to the hospital with worsening purpura and intermittent polyarthralgia affecting her feet, ankles, knees, hips, shoulders, and elbows. Labs were significant for anemia of 8.25 and mildly elevated CRP and ESR of 5.9 and 30 respectively. During hospitalization, the patient had multiple black bowel movements and her hemoglobin dropped to 6.8. Iron studies were significant for iron deficiency. She was transfused and underwent EGD and colonoscopy. EGD showed characteristic findings of gastric antral vascular ectasia (Figure 1) which was treated with APC and colonoscopy revealed erythematous mucosa throughout the entire colon (Figure 1). Biopsy of the colon mucosa was unremarkable. The patient was discharged with dermatology follow up for biopsy of purpuric skin lesions. After discharge, patient's labs resulted and showed an undetectable level of Vitamin C. She was seen at follow up by her PCP and treatment was started. Discussion: The water-soluble vitamin C plays a crucial component in collagen synthesis by activating hydrolases that form stabilizing components of the collagen triple-helix structure. When deficient, small vessels in the skin and mucosa become fragile resulting in submucosal hemorrhage in the stomach, duodenum and colon that presents as hematochezia or melena. Treatment consists of dietary modification and intravenous vitamin C replacement with resolution of lesions in only a few days. Vitamin C is replaced daily and generally normalizes in 3-4 weeks. This case demonstrates an unusual presentation of scurvy in the form of GI bleed. It is important for gastroenterologists to consider scurvy in the differential diagnosis of patients presenting with GI bleed, purpura and polyarthralgia.Figure 1.: (A) EGD images of mucosal hemorrhage seen in scurvy (B) Colonoscopy images of mucosal hemorrhage seen in scurvy.

S3678 The Use of Endoscopic Band Ligation for the Management of Gastric Antral Vascular Ectasia (GAVE)

S3678 The Use of Endoscopic Band Ligation for the Management of Gastric Antral Vascular Ectasia (GAVE)