VideoGIE
Salvage cryotherapy in portal hypertensive gastropathy
Figure 1. Endoscopic image of the antrum before cryotherapy.
Refractory upper GI bleeding requiring weekly transfusions of packed red blood cells developed in a 66-yearold man with a medical history of alcoholic liver cirrhosis and portal hypertensive gastropathy. He has had transjugular intrahepatic portosystemic shunt (TIPS) and failed argon plasma coagulation (APC) for recurrent hematemesis. Laboratory findings included international normalized ratio, 1.8; total bilirubin, 2.6 mg/dL; aspartate aminotransferase, 51 IU/L; alanine aminotransferase, 29 IU/L; and hemoglobin, 7.4 g/dL. He was scheduled for cryotherapy ablation treatment because of failed attempts with TIPS and APC at preventing recurrent upper GI bleeding. Cryotherapy procedure showed marked erythematous vascular ectasias in the entire gastric mucosa, more severe in the antrum (Fig. 1; Video 1, available online at www. giejournal.org). Liquid nitrogen ablation was applied at 3 different sites in the antrum. Ablation was applied for 2 applications of 15 seconds at each site. Successful ablation was visualized with frozen and hyperemic tissue. The
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
www.giejournal.org
patient has remained asymptomatic with a normal hemoglobin level for the past 4 weeks. Portal hypertensive gastropathy is the result of increased portal pressure. Gastric mucosal lesions are noted throughout the stomach and even other parts of the GI tract. Patients commonly have iron deficiency anemia and are transfusion dependent. Mainstay therapy includes reducing portal hypertension and treatment of ectasias with APC. In refractory cases, as previously reported, cryotherapy might be offered as a salvage procedure. DISCLOSURE The following author disclosed financial relationships relevant to this article: Dr Kahaleh is a consultant to Boston Scientific, Xlumina, and Mauna Kea Technologies and has received research support from Gore, MI Tech, Pinnacle, and Mauna Kea Technologies. All other authors disclosed no financial relationships relevant to this article. Janaki Patel, MD, Viviana Parra, MD, Prashant Kedia, MD, Reem Z. Sharaiha, MD, Michel Kahaleh, MD, FASGE, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, New York, USA
http://dx.doi.org/10.1016/j.gie.2014.05.326
Volume 81, No. 4 : 2015 GASTROINTESTINAL ENDOSCOPY 1003
Salvage cryotherapy in portal hypertensive gastropathy
Figure 1. Endoscopic image of the antrum before cryotherapy.
Refractory upper GI bleeding requiring weekly transfusions of packed red blood cells developed in a 66-yearold man with a medical history of alcoholic liver cirrhosis and portal hypertensive gastropathy. He has had transjugular intrahepatic portosystemic shunt (TIPS) and failed argon plasma coagulation (APC) for recurrent hematemesis. Laboratory findings included international normalized ratio, 1.8; total bilirubin, 2.6 mg/dL; aspartate aminotransferase, 51 IU/L; alanine aminotransferase, 29 IU/L; and hemoglobin, 7.4 g/dL. He was scheduled for cryotherapy ablation treatment because of failed attempts with TIPS and APC at preventing recurrent upper GI bleeding. Cryotherapy procedure showed marked erythematous vascular ectasias in the entire gastric mucosa, more severe in the antrum (Fig. 1; Video 1, available online at www. giejournal.org). Liquid nitrogen ablation was applied at 3 different sites in the antrum. Ablation was applied for 2 applications of 15 seconds at each site. Successful ablation was visualized with frozen and hyperemic tissue. The
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
www.giejournal.org
patient has remained asymptomatic with a normal hemoglobin level for the past 4 weeks. Portal hypertensive gastropathy is the result of increased portal pressure. Gastric mucosal lesions are noted throughout the stomach and even other parts of the GI tract. Patients commonly have iron deficiency anemia and are transfusion dependent. Mainstay therapy includes reducing portal hypertension and treatment of ectasias with APC. In refractory cases, as previously reported, cryotherapy might be offered as a salvage procedure. DISCLOSURE The following author disclosed financial relationships relevant to this article: Dr Kahaleh is a consultant to Boston Scientific, Xlumina, and Mauna Kea Technologies and has received research support from Gore, MI Tech, Pinnacle, and Mauna Kea Technologies. All other authors disclosed no financial relationships relevant to this article. Janaki Patel, MD, Viviana Parra, MD, Prashant Kedia, MD, Reem Z. Sharaiha, MD, Michel Kahaleh, MD, FASGE, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, New York, USA
http://dx.doi.org/10.1016/j.gie.2014.05.326
Volume 81, No. 4 : 2015 GASTROINTESTINAL ENDOSCOPY 1003
