Does Capsule Endoscopy Recognise Gastric Antral Vascular
Ectasia More Frequently than Conventional Endoscopy?
Reena Sidhu, David S Sanders, Mark E McAlindon
Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield,
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.
Our aim was to assess the frequency
of GAVE in patients with obscure gastrointestinal bleeding referred
for capsule endoscopy.
This study was conducted in a tertiary
This study comprised 128 consecutive
patients with obscure gastrointestinal bleeding.
All patients underwent capsule
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.
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.
Capsule endoscopy - gastric antral
vascular ectasia - gastrointestinal bleeding