title: Transjugular intrahepatic portosystemic shunt as bridge-to-surgery in refractory gastric antral vascular ectasia.
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.
authors.affiliation: Aymeric Becq, Violaine Ozenne, Xavier Dray, Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, 75010 Paris, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Becq
authors.affiliation: Aymeric Becq, Violaine Ozenne, Xavier Dray, Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, 75010 Paris, France.
authors.forename: Violaine
authors.initials: V
authors.lastname: Ozenne
authors.affiliation: Aymeric Becq, Violaine Ozenne, Xavier Dray, Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, 75010 Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Plessier
authors.affiliation: Aymeric Becq, Violaine Ozenne, Xavier Dray, Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, 75010 Paris, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Valleur
authors.affiliation: Aymeric Becq, Violaine Ozenne, Xavier Dray, Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, 75010 Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Dray
mesh_terms: D005743:Gastrectomy; D020252:Gastric Antral Vascular Ectasia / Q000601:surgery*; D006801:Humans; D008297:Male
keywords: Antrectomy; Ascites; Cirrhosis; Gastric antral vascular ectasia; Gastrointestinal bleeding; Transjugular intrahepatic portosystemic shunt