Table 1.
Literature review summary including all reported cases with GAVE in patients with CKD from 1996 to 2020.
| Case No. | Year/Author | No. of reported cases | Age/Sex | Presentation | CKD /ESRD 2ry to | Liver diseases | Duration on dialysis before diagnosis of GAVE | Initial Hgb (g/dL) |
|---|---|---|---|---|---|---|---|---|
| 1 | 1996 Yorioka N, et al [12] | 1 | 70/F | Anemia | Chronic pyelonephritis | No | 9 years | 4.1 |
| 2 | 1996 Hermans C, et al [20] | 1 | 63/M | Anemia | Chronic glomerulone- phritis | No | 6 years | 6.3 |
| 3 | 1998 Chien CC, et al [13] | 1 | 50/F | Anemia | NA | No | 5 years | NA |
| 4 | 2000 Fábián G, et al [21] | 1 | 77/F | Anemia | Hypertensive Nephropathy | No | 2 years | 3.6 |
| 5 | 2003Tomori K, et al [14] | 2 | 69/M | Anemia Hematemesis | Hypertensive Nephropathy | No | 6 months | NA |
| 6 | 57/F | Anemia | Hypertensive Nephropathy | No | 2 years | NA | ||
| 7 | 2005 Pljesa S, et al [22] | 1 | 54/F | Anemia Melena | Chronic pyelonephritis | No | 7 years | 4 |
| 8 | 2006 Stefanidis I, et al [23] | 2 | 61/F | Melena Hypotension during dialysis | Autosomal dominant polycystic kidney disease | No | 10 months | 7.6 |
| 9 | 72/F | Anemia Melena | Chronic interstitial nephritis | No | 2 years (21 months) | NA | ||
| 10 | 2007 George P, et al [24] | 1 | 42/M | Anemia Melena | Chronic glomerulone- phritis Post-renal transplantation (15 years ago) Chronic allograft nephropathy | Decompensated cirrhosis 2 ry to hepatitis B | Post-renal transplantation | 4 |
| 11 | 2009 Nguyen H, et al [4] | 1 | 63/F | Abdominal pain Vomiting Melena | Diabetic and Hypertensive Nephropathy | Chronic hepatitis C infection, Portal HTN | NA | 6.8 |
| 12 | 2010 Lin W-H, et al [25] | 1 | 38/F | Anemia Melena | NA | No | 7 years | NA |
| 13 | 2011 Iguchi A, et al [6] | 3 | 67/F | Anemia | Chronic glomerulonephritis | No | Not on dialysis | 5.8 |
| 14 | 61/F | Anemia Melena | Hepatorenal syndrome | Alcoholic liver cirrhosis | Not on dialysis | 4.8 | ||
| 15 | 66/F | Anemia | Autosomal dominant polycystic kidney disease | No | Not on dialysis | 4.8 | ||
| 16 | 2012 Lata S, et al [26] | 1 | Middle age/F | Anemia Melena | Hypertensive Nephropathy | Chronic liver disease 2ry to hepatitis C virus | 6 years | 4.3 |
| 17 | 2013 Jinga M, et al [27] | 1 | 42/F | Anemia Abdominal pain | SLE | No | 3 years (40 months) | 6.7 |
| 18 | 2014 Pisharam JK, et al [15] | 4 | 59/F | Anemia | Diabetic Nephropathy | No | 4 years | 8 |
| 19 | 67/M | Anemia Hematemesis | Diabetic Nephropathy | No | 5 years | 5.7 | ||
| 20 | 71/F | Melena | Diabetic Nephropathy | Chronic hepatitis B infection | 2 years | 5.6 | ||
| 21 | 50/F | Anemia | Diabetic Nephropathy | No | 3 years | 8.3 | ||
| 22 | 2014 Ahn Y, et al [5] | 1 | 52/F | Anemia Melena | Diabetic and Hypertensive Nephropathy | Non-alcoholic liver cirrhosis complicated byortal HTN | 2 years | 5.5 |
| 23 | 2014 Kilincalp S, et al [28] | 1 | 54/M | Anemia | Hypertensive Nephropathy Post-renal transplantation (5 years ago) | No | Post-renal transplantation | 5.8 |
| 24 | 2014 Shimamura Y, et al [29] | 1 | 64/F | Anemia UGIB | Diabetic Nephropathy | No | NA | 6.7 |
| 25 | 2015 Lee DJR, et al [16] | 1 | 40/F | Anemia Melena Hematemesis Hypotension during dialysis | Hypertensive Nephropathy | No | 9 years | 4.8 |
| 26 | 2018 Rimševičius L, et al [30] | 4 | 66/F | Anemia Melena | Diabetic and Hypertensive Nephropathy | No | 3 years | 6 |
| 27 | 75/M | Anemia Melena | Hypertensive Nephropathy | No | 5 years | 11.8 | ||
| 28 | 64/M | Anemia | Chronic pyelonephritis | No | 5 years | 9.8 | ||
| 29 | 80/M | Anemia Melena | NA | No | Not on dialysis | 7.7 | ||
| 30 | 2019 Santos S, et al [31] | 1 | 49/M | Anemia Melena | Chronic glomerulonephritis | No | NA | 6.3 |
| 31 | 2020 Kang SH, et al [32] | 1 | 76/F | Anemia Melena Hematemesis | SLE | No | 5 months | 5.5 |
| Case No. | EGD/Colonoscopy finding | Medical management | Endoscopic management | Surgical management | Management outcome |
|---|---|---|---|---|---|
| 1 | 1st EGD: Superficial erosion in the gastric antrum 2nd EGD: Red linear streaks ascending to the pylorus |
Conservative | No | No | Blood transfusion dependent which improve within 3 months of HD cessation and CAPD initiation |
| 2 | Longitudinal folds of dilated vessels radiating from the pylorus Colonoscopy: Normal | Hormonal therapy (Estrogen and Progesterone) | No | No | Successful |
| 3 | 1st EGD: Antral gastritis 2nd EGD: Typical picture of watermelon stomach |
Hormonal therapy (Norethisterone and Ethynyloestradol) | No | No | Successful |
| 4 | – Some erosions in the corpus of the stomach and slightly protruding, parallel longitudinal antral streaks converging on the pylorus – Two angiodysplastic lesions in the postbulbar duodenum Colonoscopy: – Diffuse atrophic changes of the intestinal mucosa with several angiodysplasias, 5–7 mm in diameter – Some diverticuli in the sigmoid colon |
Hormonal therapy (Estrogen and Progesterone) | No | No | Successful |
| 5 | 1st EGD: oozing in the antrum, and gastritis and esophagitis with sliding hernia 2nd EGD: Typical picture of watermelon stomach |
No | APC | No | Successful |
| 6 | Oozing in the antrum with diffuse vasodilation in the antrum | No | APC | No | Successful |
| 7 | Visible columns of vessels transversing the antrum in longitudinal folds and converging in the pylorus, with clear red spots and surrounding hyperemy covered by drops of fresh blood Colonoscopy: Normal |
No | Sclerotherapy (Electrocoagulation and APC were not available) | Total gastrectomy | Successful |
| 8 | – Characteristic antral appearance of watermelon stomach – Erythematous stripes in the cardia – Diaphragmatic hernia |
No | Electrocoagulation (10 sessions) | No | Successful |
| 9 | Typical watermelon stomach (longitudinal rugal folds transversing the antrum and converging on the pylorus) | No | Laser photocoagulation Electrocoagulation | No | Death* |
| 10 | Portal hypertensive gastropathy with gastric antral vascular ectasia Colonoscopy: Normal |
No | Electrocoagulation (4 sessions) APC | No | Death** |
| 11 | – Esophageal varices and PHG 2 years before GAVE dx Extensive vascular ectasias and patchy erythema in the distal antrum Colonoscopy: Hemorrhoids |
No | Not tried due to diffuse and advanced vascular ectasias | Subtotal gastrectomy | Successful |
| 12 | – Multiple esophageal ulcers, gastric ulcers, and gastritis. before GAVE dx – Ectatic vessels along the longitudinal folds of the antrum |
No | APC (5 sessions) | No | Successful |
| 13 | Watermelon stomach at the antrum | No | APC (2 sessions) | No | Successful |
| 14 | Diffuse antral vascular ectasia | No | APC (2 sessions) | No | Successful |
| 15 | Watermelon stomach | No | APC (3 sessions) | No | Successful |
| 16 | – Multiple linear gastric vascular malformations in the antrum with spurt oozing Ectasias in the cardia and the duodenum Colonoscopy: Normal |
No | APC | No | Successful |
| 17 | Visible columns of red tortuous ectatic vessels along the longitudinal folds of the antrum | No | APC (Multiple sessions) | No | Successful |
| 18 | 1st EGD: – Hemorrhagic antral gastritis with self-limiting oozing 2nd EGD: – Diffuse erythematous patches in the antrum – Vascular ectasia located at the gastro-esophageal junction |
No | Combination of heater probe and coagulation with open snare (2 sessions) – APC was not available | No | Death due to sepsis |
| 19 | 1st EGD: – Gastritis and a fundal polyp 2nd EGD: – Mild esophagitis, some fresh blood in the distal stomach and multiple antral folds with erythematous patches |
No | Thermal coagulation (3 sessions) | No | Death due to sepsis |
| 20 | 1st EGD: – Antral gastritis and few telangiectasias 2nd EGD: – Fresh blood in the antrum with prominent antral folds and gastritis |
No | Adrenaline injection Thermal coagulation | No | Blood transfusion dependent |
| 21 | Two prominent antral folds and 2 linear erythematous streaks | Conservative# | No | No | Successful |
| 22 | Single gastric antral angiodysplastic lesion with hemorrhage and multiple gastric angioectasias with no bleeding | No | APC (Multiple sessions) | Gastrectomy was considered but patient was high risk | Blood transfusion dependent |
| 23 | Raised erythematous stripes radiating from pylorus up to the lower part of gastric body | No | APC (3 sessions) | No | Successful |
| 24 | Red tortuous ectatic vessels along the longitudinal folds of the antrum | No | APC (3 sessions) | No | Successful |
| 25 | 1st EGD: Distal erosive esophagitis and intense antral erosive gastritis 2nd EGD: Longitudinal antral folds containing visible stripes of tortuous red ecstatic vessels with bleeding Colonoscopy: Normal |
No | APC | No | Successful |
| 26 | Multiple linear gastric vascular malformations with signs of bleeding | No | APC | No | Successful |
| 27 | Multiple linear gastric vascular malformations in the antrum, with 3 mm lesions and no signs of bleeding | No | APC | No | Successful |
| 28 | Multiple l ar gastric vascular malformations in the antrum without any signs of bleeding | No | APC | No | Successful |
| 29 | Multiple linear gastric vascular malformations in the antrum with small signs of bleeding | No | APC | No | Successful |
| 30 | Multiple gastric angiodysplasias arranged in radiating streaks with active bleeding | Bevacizumab | APC | No | Successful |
| 31 | Multiple erythematous raised hyperemic mucosal lesions at the distal antrum without active bleeding | No | APC (8 sessions) | No | Blood transfusion dependent |
CKD – chronic kidney disease; ESRD – end-stage renal disease; F – female; M – male; NA – not available.
*
Patient died from a new stroke;
**
Patient died later from sepsis;
#
only managed by Iron and Recombinant Human Erythropoietin.