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World J Gastroenterol. May 14, 2015; 21(18): 5749-5750
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5749
Transjugular intrahepatic portosystemic shunt as bridge-to-surgery in refractory gastric antral vascular ectasia
Aymeric Becq, Violaine Ozenne, Aurélie Plessier, Patrice Valleur, Xavier Dray
Aymeric Becq, Violaine Ozenne, Xavier Dray, Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, 75010 Paris, France
Aurélie Plessier, Department of Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Beaujon Hospital, 75010 Paris, France
Patrice Valleur, Department of Surgery, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, 75010 Paris, France
Author contributions: Becq A, Ozenne V, Plessier A, Valleur P and Dray X contributed equally to the patient’s care and to this work; Becq A and Dray X wrote the paper.
Conflict-of-interest: None of the authors have any conflict-of-interest related to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xavier Dray, MD, PhD, Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, 2, rue Ambroise Paré, 75010 Paris, France. xavier.dray@lrb.aphp.fr
Telephone: +33-1-49952545 Fax: +33-1-49952577
Received: December 12, 2014
Peer-review started: December 12, 2014
First decision: December 26, 2014
Revised: January 23, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: May 14, 2015
Processing time: 157 Days and 12.1 Hours
Abstract

Gastric antral vascular ectasia (GAVE) may cause gastrointestinal bleeding (GIB). The treatment of GAVE relies on endoscopic approaches such as electrocoagulation (argon plasma coagulation, laser therapy, heater probe therapy, radiofrequency ablation), cryotherapy, and band ligation. In refractory cases, antrectomy may be considered. In the event of an associated cirrhosis and portal hypertension, it has been suggested that antrectomy could be an option, provided the mortality risk isn't considered too great. We report the case of a 67-year-old cirrhotic patient who presented with GAVE related GIB, unresponsive to multiple endoscopic treatments. The patient had a good liver function (model for end-stage disease 10). After a multidisciplinary meeting, a transjugular intrahepatic portosystemic shunt (TIPS) procedure was performed, in order to treat the cirrhosis associated ascites. The outcome was successful. An antrectomy was then performed, with no recurrence of GIB and no transfusion need during three months of follow up. In this case, the TIPS procedure achieved a complete ascites regression, allowing a safer surgical treatment of the GAVE-related GIB.

Keywords: Gastric antral vascular ectasia; Gastrointestinal bleeding; Cirrhosis; Ascites; Transjugular intrahepatic portosystemic shunt; Antrectomy

Core tip: Gastric antral vascular ectasia (GAVE) may cause gastrointestinal bleeding. Antrectomy should be considered in refractory cases. In the event of an associated cirrhosis and portal hypertension, decision of surgery must be pondered given a higher risk. We report the case of a refractory GAVE, in a cirrhotic patient with ascites. A transjugular intrahepatic portosystemic shunt procedure was performed, allowing complete ascites regression. The surgery was then juged to be less risky. An antrectomy was thus performed, with favorable outcome. Antrectomy may be an option in refractory GAVE, in this setting, provided liver function is sufficient and cirrhosis is compensated.