From the Guidelines
TIPS is not recommended for the treatment of GAVE (Gastric Antral Vascular Ectasia) as it does not address the underlying pathophysiology of the condition. GAVE is a distinct clinical entity characterized by vascular ectasia in the gastric antrum, and its management should focus on endoscopic and medical therapies that directly target the lesions. According to the evidence, TIPS has been found to be successful in improving the appearances of portal hypertensive gastropathy (PHG) and reducing transfusion requirements in patients refractory to conservative therapies, but it does not have a role in the management of bleeding solely from GAVE 1.
The current guidelines and studies suggest that endoscopic therapies such as argon plasma coagulation, radiofrequency ablation, or endoscopic band ligation should be considered as first-line treatments for GAVE. Medical therapies, including tranexamic acid, may also be used in refractory cases. Surgical antrectomy remains an option for severe cases unresponsive to other treatments. It is essential to differentiate GAVE from PHG, as they can co-exist, and TIPS may be considered in cases with co-existing PHG, but not as a primary treatment for GAVE.
Key points to consider in the management of GAVE include:
- Endoscopic therapies as first-line treatments
- Medical therapies for refractory cases
- Surgical antrectomy as a last resort
- Differentiation from PHG and consideration of TIPS in co-existing cases
- The lack of evidence supporting the use of TIPS in the management of bleeding solely from GAVE 1.
In clinical practice, it is crucial to prioritize the most effective and evidence-based treatments for GAVE, and TIPS should not be considered a primary treatment option for this condition.
From the Research
Treatment of GAVE
- GAVE is a distinct condition that can cause acute and chronic upper gastrointestinal blood loss, and its treatment differs from that of portal hypertensive gastropathy (PHG) 2, 3, 4, 5.
- The primary treatment for GAVE is endoscopic ablation of the lesion using techniques such as argon plasma coagulation, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, or heater probe 2, 3, 4, 5.
- Transjugular intrahepatic portosystemic shunt (TIPS) is not typically used to treat GAVE, as it does not reduce the bleeding risk in patients with GAVE 2, 3.
- However, TIPS may be used as a bridge-to-surgery in refractory cases of GAVE, particularly in patients with cirrhosis and portal hypertension 6.
- Surgical antrectomy may be considered in selected patients with severe recurrent bleeding or uncontrollable acute bleeding from GAVE, but it is associated with a high mortality risk 3, 4, 5.
Use of TIPS in GAVE
- TIPS is not a standard treatment for GAVE, and its use is generally limited to patients with cirrhosis and portal hypertension who require a bridge-to-surgery 6.
- The use of TIPS in GAVE is not supported by most studies, which suggest that endoscopic ablation is the preferred treatment 2, 3, 4, 5.
- However, TIPS may be considered in exceptional cases where endoscopic treatment has failed and surgical antrectomy is not feasible 6.