We determined the incidence of severe
bleeding from
gastric antral vascular ectasia (GAVE) after myeloablative hematopoietic cell transplant and the outcomes
after treatment with endoscopic
neodymium:
YAG laser photocoagulation. From 1992 to 2005, the incidence of severe
bleeding from GAVE was 6/4491 (0.13%). All patients had received oral
busulfan and four had
sinusoidal obstruction syndrome. Gastrointestinal
bleeding began a median of 53 days after transplant (range 15-2952). After GAVE was diagnosed by endoscopic and histologic findings, a median of three (range 2-7) sessions of
laser therapy were required to control the
bleeding with a median of 2737 J (range 1117-6160 J) per session. A median of 16 units (range 4-44) had been transfused prior to
laser therapy and a median of four additional units (range 0-113) were transfused until
bleeding was controlled. All patients were followed for at least 70 days after the last
laser therapy session, with no further episodes of
bleeding. Complications were mild and included
abdominal pain and asymptomatic ulceration; however, one patient required
gastrectomy due to gastric
necrosis following transarterial embolizations. In summary, severe
bleeding from GAVE is rare following hematopoietic cell transplant. Treatment with endoscopic
therapy using the
Nd:YAG laser is safe and effective.