Clin Exp Nephrol DOI 10.1007/s10157-014-1069-8
IMAGES IN NEPHROLOGY
Watermelon stomach: gastric antral vascular ectasia Yoshinosuke Shimamura • Hideaki Koga Hideki Takizawa
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Received: 7 November 2014 / Accepted: 30 November 2014 Ó Japanese Society of Nephrology 2014
Keywords Gastric antral vascular ectasia Chronic kidney disease Argon plasma coagulation A 64-year-old Japanese female with transfusion-dependent anemia and chronic kidney disease (CKD) due to diabetic nephropathy presented with upper gastrointestinal bleeding. Red blood cell count was 165 9 104/lL, and hemoglobin level was 6.7 g/dL. Endoscopy revealed red tortuous ectatic vessels along the longitudinal folds of the antrum (Fig. 1), which was characteristic of gastric antral vascular ectasia (GAVE). The patient was treated successfully with three sessions of argon plasma coagulation (APC) (Fig. 2). Her hemoglobin level improved to 10.2 g/dL after the treatment, which helped abolish transfusion dependence, and she had no relapse of symptoms. GAVE accounts for up to 4 % of non-variceal upper gastrointestinal bleeding [1], and is associated with CKD, autoimmune connective tissue diseases, bone marrow transplantation [2], and renal transplantation [3]. APC is the first-line treatment because it is more effective than pharmacological treatment, and leads to abolish transfusion requirements in 77 % of patients [4].
Fig. 1 Initial endoscopy showed tortuous ectatic vessels along the longitudinal folds of the antrum
Y. Shimamura (&) H. Takizawa Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan e-mail: [email protected] H. Koga Center for Gastrointestinal Diseases, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan
Fig. 2 Follow-up endoscopy showed disappearance of ectatic vessels after APC
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Clin Exp Nephrol Conflict of interest interest (COI).
The authors state that they have no conflict of
References 1. Dulai GS, Jensen DM, Kovacs TO. Endoscopic treatment outcomes in watermelon stomach patients with and without portal hypertension. Endoscopy. 2004;36(1):68–72. 2. Selinger CP, Ang YS. Gastric antral vascular ectasia (GAVE): an update on clinical presentation, pathophysiology and treatment. Digestion. 2008;77:131–7.
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3. Kilincalp S, Ustun Y, Karaahmet F, et al. A new cause of severe anemia in renal transplant recipients: watermelon stomach. Clin Exp Nephrol. 2014. doi:10.1007/s10157-014-1035-5. 4. Kwan V, Bourke MJ, Williams SJ, et al. Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up. Am J Gastroenterol. 2006;101:58–63.
IMAGES IN NEPHROLOGY
Watermelon stomach: gastric antral vascular ectasia Yoshinosuke Shimamura • Hideaki Koga Hideki Takizawa
•
Received: 7 November 2014 / Accepted: 30 November 2014 Ó Japanese Society of Nephrology 2014
Keywords Gastric antral vascular ectasia Chronic kidney disease Argon plasma coagulation A 64-year-old Japanese female with transfusion-dependent anemia and chronic kidney disease (CKD) due to diabetic nephropathy presented with upper gastrointestinal bleeding. Red blood cell count was 165 9 104/lL, and hemoglobin level was 6.7 g/dL. Endoscopy revealed red tortuous ectatic vessels along the longitudinal folds of the antrum (Fig. 1), which was characteristic of gastric antral vascular ectasia (GAVE). The patient was treated successfully with three sessions of argon plasma coagulation (APC) (Fig. 2). Her hemoglobin level improved to 10.2 g/dL after the treatment, which helped abolish transfusion dependence, and she had no relapse of symptoms. GAVE accounts for up to 4 % of non-variceal upper gastrointestinal bleeding [1], and is associated with CKD, autoimmune connective tissue diseases, bone marrow transplantation [2], and renal transplantation [3]. APC is the first-line treatment because it is more effective than pharmacological treatment, and leads to abolish transfusion requirements in 77 % of patients [4].
Fig. 1 Initial endoscopy showed tortuous ectatic vessels along the longitudinal folds of the antrum
Y. Shimamura (&) H. Takizawa Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan e-mail: [email protected] H. Koga Center for Gastrointestinal Diseases, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan
Fig. 2 Follow-up endoscopy showed disappearance of ectatic vessels after APC
123
Clin Exp Nephrol Conflict of interest interest (COI).
The authors state that they have no conflict of
References 1. Dulai GS, Jensen DM, Kovacs TO. Endoscopic treatment outcomes in watermelon stomach patients with and without portal hypertension. Endoscopy. 2004;36(1):68–72. 2. Selinger CP, Ang YS. Gastric antral vascular ectasia (GAVE): an update on clinical presentation, pathophysiology and treatment. Digestion. 2008;77:131–7.
123
3. Kilincalp S, Ustun Y, Karaahmet F, et al. A new cause of severe anemia in renal transplant recipients: watermelon stomach. Clin Exp Nephrol. 2014. doi:10.1007/s10157-014-1035-5. 4. Kwan V, Bourke MJ, Williams SJ, et al. Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up. Am J Gastroenterol. 2006;101:58–63.
