Description:
This 76 year old lady was self referred for management of GAVE. Over the prior 5 years, she had required over 50 units of PRBCs and had undergone a similar number of upper endoscopies with fulguration in an attempt to stabilize her bleeding. She has stable RA on no meds, and had undergone a AAA repair 5 years previously. There was no prior history of cardiac disease or portal hypertension.
On her EGD, we see slow oozing from antral GAVE. The lesions extend into the pyloric channel. The argon plasma coagulation unit is used to fulgurate all the visible telangiectasias.
She returns 3 weeks later. Immediately, we can see a decrease in the number of telangiectasias and there is no visible bleeding present. Already she has seen a decrease in the tempo of her transfusion requirement. The few remaining lesions are ablated.
Either a side or forward firing probe can be used. Complications from APC in the stomach are uncommon.
The patient returned for her next treatment 10 days later. Fewer lesions are seen at this time.
Contributed By:
Peter B. Kelsey, M.D., Harvard Medical School, Massachusetts General Hospital
Nicole Marie Martin, Harvard Medical School
