- Email: [email protected]
Diffuse antral vascular ectasia: EUS after argon plasma coagulation
DIFFUSE ANTRAL VASCULAR ECTASIA: EUS AFTER ARGON PLASMA COAGULATION
A
B
C D A 71-year-old man with cirrhosis was admitted with melena. Upper endoscopy showed diffuse capillary dilation and redness in the antrum, and a diagnosis of diffuse antral vascular ectasia was made (A). EUS with a 20 MHz US catheter probe performed under constant filling of deaerated water in the stomach demonstrated marked thickening of the second and third sonographic layers (mucosa and submucosa, respectively) as well as small hypoechoic spaces within these layers (B; arrow, submucosa; arrowheads, muscularis propria). The vascular lesions were treated by argon plasma coagulation without complication. Tests for fecal occult blood reverted to negative. Upper endoscopy 7 weeks later revealed disappearance of the dilated capillaries and no cicatricial VOLUME 54, NO. 5, 2001
narrowing of the pylorus (C). EUS also demonstrated disappearance of the luminal structures in the second and third sonographic layers and no evidence of injury to the fourth sonographic layer, the muscularis propria (D; arrow, submucosa; arrowheads, muscularis propria). The patient had no further bleeding. Ryushi Shudo, MD, FACP Yasuyuki Yazaki, MD Shinobu Sakurai, MD Hiroshi Uenishi, MD Hiroto Yamada, MD Kenji Sugawara, MD Digestive Disease Center Kobayashi Hospital Kitami, Hokkaido, Japan doi:10.1067/mge.2001.118965 GASTROINTESTINAL ENDOSCOPY 623
A
B
C D A 71-year-old man with cirrhosis was admitted with melena. Upper endoscopy showed diffuse capillary dilation and redness in the antrum, and a diagnosis of diffuse antral vascular ectasia was made (A). EUS with a 20 MHz US catheter probe performed under constant filling of deaerated water in the stomach demonstrated marked thickening of the second and third sonographic layers (mucosa and submucosa, respectively) as well as small hypoechoic spaces within these layers (B; arrow, submucosa; arrowheads, muscularis propria). The vascular lesions were treated by argon plasma coagulation without complication. Tests for fecal occult blood reverted to negative. Upper endoscopy 7 weeks later revealed disappearance of the dilated capillaries and no cicatricial VOLUME 54, NO. 5, 2001
narrowing of the pylorus (C). EUS also demonstrated disappearance of the luminal structures in the second and third sonographic layers and no evidence of injury to the fourth sonographic layer, the muscularis propria (D; arrow, submucosa; arrowheads, muscularis propria). The patient had no further bleeding. Ryushi Shudo, MD, FACP Yasuyuki Yazaki, MD Shinobu Sakurai, MD Hiroshi Uenishi, MD Hiroto Yamada, MD Kenji Sugawara, MD Digestive Disease Center Kobayashi Hospital Kitami, Hokkaido, Japan doi:10.1067/mge.2001.118965 GASTROINTESTINAL ENDOSCOPY 623