In:
Zeitschrift für Gastroenterologie, Georg Thieme Verlag KG, Vol. 61, No. 03 ( 2023-03), p. 275-279
Abstract:
Gastric antral vascular ectasia (GAVE) syndrome is a rare but often challenging etiology
of upper gastrointestinal bleeding (UGIB). We report on a 60-year-old patient with liver cirrhosis, GAVE syndrome and recurrent and
refractory GAVE-related UGIB. During a 5-month hospital stay, the patient required a total of 82 packed red blood cells (pRBCs) and 23 gastroscopies. All endoscopic approaches, including
multiple argon plasma coagulation and band ligation sessions, remained unsuccessful. Antrectomy was waived because of the high perioperative mortality risk in Child-Pugh B liver cirrhosis. TIPS insertion also failed to control the bleeding. Only continuous intravenous
octreotide infusion slowed the bleeding, but this forced the patient to be hospitalized. After 144 inpatient days, administration of subcutaneous octreotide allowed the patient to be
discharged. However, the patient continued to require two pRBCs every 2–3 weeks. Based on recently published data, we treated the patient with bevacizumab (anti-VEGF antibody)
off-label at a dose of 7.5 mg/kg body weight every three weeks in nine single doses over six months. Since the first administration, the patient has remained transfusion-free, has not
required hospitalization, and leads an active life, working full-time. He remains on octreotide, which has been reduced but not yet discontinued. Additionally, no adverse events
were observed. Thus, in patients with liver cirrhosis and refractory GAVE-related hemorrhage, bevacizumab
combined with subcutaneous octreotide should be considered as an effective and durable pharmacological treatment option.
Type of Medium:
Online Resource
ISSN:
0044-2771
,
1439-7803
Language:
English
Publisher:
Georg Thieme Verlag KG
Publication Date:
2023
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