C0685 - Gastric Antral Vascular Ectasia in Cirrhotic Patients: A Retrospective Single-Center Study

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Howard Chung, MD

New York University School of Medicine
Brooklyn, NY

Howard Chung, MD¹, Shu-Yen Chan, MD, MS², Yichen Wang, MD³, Negar Niknam, MD⁴
¹New York University School of Medicine, Brooklyn, NY; ²Taipei Medical University Hospital, Harrisburg, PA; ³Trinity Health of New England, Springfield, MA; ⁴Queens Hospital Center, Queens, NY

Introduction: Gastric antral vascular ectasia (GAVE) is a rare cause of GI bleeding. It is associated with portal hypertension, connective tissue disease, and chronic kidney disease. The treatments include medical, endoscopic, and surgical interventions. In this article, we analyzed the characteristics of GAVE patients with cirrhosis and the outcomes of treatments.

Methods: We conducted a single-center retrospective study by reviewing the patients with both diagnoses of GAVE and liver cirrhosis who had followed up in NYU Langone healthcare system between 2012 to 2022. IRB exemption was obtained.

Results: A total of 27 patients (16 females and 11 males) met our inclusion criteria. The mean age was 66.3 years old. Alcoholic cirrhosis and NAFLD are the most common etiologies of cirrhosis with GAVE. 21 cases had a history of transfusion. 17 patients were found to have esophageal varices during the endoscopic exam. 85% of GAVE was treated with endoscopic argon plasma coagulation (APC), including four were treated with APC plus band ligation (BL) and one was treated with APC plus radiofrequency ablation (RFA). All GAVE with active bleeding were treated with APC. However, patients without active bleeding from GAVE were also treated with APC if there was cirrhosis complicated by esophageal varices, low hemoglobin, or sign of active bleeding. No significant difference in hemoglobin before and after APC (9.02 vs 9.36, P = 0.077) was noticed. Most patients are now actively following up with intermittent blood transfusion and APC treatment as needed. Only four patients expired due to advanced liver disease, not GI bleeding. No APC-related complication or mortality was noted in this study.

Discussion: APC was the most used first-line endoscopic therapy in cirrhotic patients with GAVE. Our study revealed that it is safe but not curative. Most patients required multiple sessions with intermittent transfusion. A long-term follow-up is required to thoroughly evaluate the outcomes of different interventions.

Total patients number	27 (100%)
Mean age	66.3 years old
Gender - Male - Female	11 (41%) 16 (59%)
Etiology of cirrhosis - Alcoholic cirrhosis - NASH/NAFLD - HBV - HCV - PBC - schistosomiasis - unspecified	9 (33%) 10 (37%) 1 (4%) 1 (4%) 1 (4%) 1 (4%) 4 (15%)
Esophageal varices found during EGD	17 (63%)
Active bleeding from GAVE found during EGD	11 (41%)
Mean Hb before vs after interventions	9.02 vs 9.36 (P= 0.077)
History of transfusion - Yes - No	21 (78%) 6 (22%)
Treatment of GAVE - medicine - APC - BL - RFA	3 (11%) 23 (85%) 5 (19%) 1 (4%)
Mean of APC sessions	2.67

Table: The patient characteristics of GAVE in cirrhosis

Disclosures:

Howard Chung indicated no relevant financial relationships.

Shu-Yen Chan indicated no relevant financial relationships.

Yichen Wang indicated no relevant financial relationships.

Negar Niknam indicated no relevant financial relationships.

Howard Chung, MD¹, Shu-Yen Chan, MD, MS², Yichen Wang, MD³, Negar Niknam, MD⁴. C0685 - Gastric Antral Vascular Ectasia in Cirrhotic Patients: A Retrospective Single-Center Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.