Does capsule endoscopy recognise gastric antral vascular ectasia more frequently than conventional endoscopy?
BACKGROUND
Gastric antral vascular ectasia (GAVE) is a rare cause of obscure gastrointestinal bleeding which can be difficult to recognise endoscopically. Capsule endoscopy is primarily designed to image the small bowel, but may identify gastric and colonic lesions. There have been few reported cases of GAVE diagnosed by capsule endoscopy in the literature.


OBJECTIVE
Our aim was to assess the frequency of GAVE in patients with obscure gastrointestinal bleeding referred for capsule endoscopy.


METHODS
Case series.


METHODS
This study was conducted in a tertiary referral hospital. PATIENTS. This study comprised 128 consecutive patients with obscure gastrointestinal bleeding.


METHODS
All patients underwent capsule endoscopy. RESULTS. Six patients were diagnosed with GAVE on the basis of the capsule endoscopy findings (4.7%, five female, median age 71.5 years). All patients had previously had numerous gastrointestinal investigations prior to capsule endoscopy. Five patients to date have been treated with argon plasma coagulation of their vascular lesions. This has resulted in stabilisation of their haemoglobin and cessation of blood transfusions in 4/5 cases with an average follow up period of 15 months.


CONCLUSIONS
GAVE is commonly missed at gastroscopy and accounted for 4.7% of patients referred for capsule endoscopy with obscure gastrointestinal bleeding (in our series). This case series represents the largest number of GAVE recognised by capsule endoscopy. In the presence of any of the reported risk/associated factors for GAVE the gastroenterologist interpreting the capsule images should have a high index of suspicion.
Sidhu
Reena
R
Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK. reena_sidhu@yahoo.com
Sanders
David S
DS
McAlindon
Mark E
ME
D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation; D001803:Blood Transfusion; D053704:Capsule Endoscopy; D005260:Female; D020252:Gastric Antral Vascular Ectasia / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016896:Treatment Outcome