Gastric Miscellaneous ,El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Enormous gastric leiomyoma with a central umbilicated ulceration. A 34 year-old male with hepatic cirrhosis and esophageal varices presented a submucosal tumor with central umbilicated ulcer. He was asymptomatic at the time of dignosis. The central location of this ulcer is characteristic for an intramural neoplasm such a leiomyoma.

Video Endoscopic Sequence 1 of 6.

 Enormous Gastric Leiomyoma with a central umbilicated
 ulceration.

 A 34 year-old male with hepatic cirrhosis and esophageal
 varices, presented a submucosal tumor with central
 umbilicated ulcer. He was asymptomatic at the time of
 diagnosis.
 The central location of this ulcer is characteristic for an
 intramural neoplasm such a leiomyoma.


                                          Medline.
 
 For more endoscopic details download the video clips by
 clicking on the endoscopic image.
 All endoscopic images shown in this Atlas contain a video
 clip. We recommend seeing the video clips in full screen
 mode.

Another view of the tumor described above. Grossly, leiomyomas of the stomach most frequently develop in the lower half of the stomach but may also be seen at the fundus. They are usually smaller than 3 cm but occasionally may be large at the time of diagnosis. Ulceration of the mucosa overlying the tumor is reported in 50 - 70% of tumors larger than 2 cm in diameter. Most gastric leiomyomas present as endogastric submucosal lesions and may be pedunculated but some, originating from the serosa, develop mainly as exogastric masses.

Video Endoscopic Sequence 2 of 6.

Another view of the tumor described above.

 Grossly, leiomyomas of the stomach most frequently
 develop in the lower half of the stomach but may also be
 seen at the fundus. They are usually smaller than 3 cm but
 occasionally may be large at the time of diagnosis.
 Ulceration of the mucosa overlying the tumor is reported in
 50 – 70% of tumors larger than 2 cm in diameter. Most
 gastric leiomyomas present as endogastric submucosal
 lesions and may be pedunculated but some, originating from
 the serosa, develop mainly as exogastric masses.    

Lateral view of this submucosal tumor. The classic or usual GI tract leiomyoma has a similar morphologic appearance to leiomyomas in other organs. In the gut, they are usually small, and well circumscribed. The tumors typically arise from the muscularis propria; growth may be intraluminal, extraluminal, or a combination with a dumb-bell shape. Leiomyomas can range in size from less than 0.5 cm (microleiomyomas) to as large as 30 cm.

 Video Endoscopic Sequence 3 of 6.

Lateral view of this submucosal tumor.

 The classic or usual GI tract leiomyoma has a similar
 morphologic appearance to leiomyomas in other organs. In
 the gut, they are usually small, and well circumscribed. The
 tumors typically arise from the muscularis propria; growth
 may be intraluminal, extraluminal, or a combination with a
 dumb-bell shape. Leiomyomas can range in size from less
 than 0.5 cm (microleiomyomas) to as large as 30 cm.

                                          Medline.
Most leiomyomas of stomach are asymptomatic but ulceration may cause pain and signs of gastrointestinal bleeding. Microscopically, leiomyomas are formed of fasicles of benign-appearing spindle cells without nuclear atypia; mitoses are sparse or absent, and necrosis virtually never occurs. The nucleus is centrally located and oval but may be displaced to one side by distinct vacuoles suggesting signet-ring cells. These vacuoles do not contain fat or mucosubstances, which differentiates them from liposarcomas and carcinomas.

Video Endoscopic Sequence 4 of 6.

 Most leiomyomas of stomach are asymptomatic but
 ulceration may cause pain and signs of gastrointestinal
 bleeding.

 Microscopically, leiomyomas are formed of fasicles of
 benign-appearing spindle cells without nuclear atypia;
 mitoses are sparse or absent, and necrosis virtually never
 occurs. The nucleus is centrally located and oval but may
 be displaced to one side by distinct vacuoles suggesting
 signet-ring cells. These vacuoles do not contain fat or
 mucosubstances, which differentiates them from
 liposarcomas and carcinomas.

                                          Medline.
Magnifycation of the tip of the leiomyoma. A Magnifying endoscope was used.

Video Endoscopic Sequence 5 of 6.


 Magnifycation of the tip of the leiomyoma.
 A Magnifying endoscope was used.

 

                   

                                          Medline.

Some biopsies were taken and proved to be a leiomyoma.

Video Endoscopic Sequence 6 of 6.

Some biopsies were taken and proved to be a leiomyoma.

 
Extrinsic compression due to malign ascites. This 34 year-old male that, two years previously was diagnosed as having colon cancer, now present a severe abdominal bulking due to a malign ascites.

Video Endoscopic Sequence 1 of 10.

Extrinsic compression due to malign ascites

 This 34 year-old male that, two years previously was diagnosed as having colon cancer, now present a severe abdominal bulking due to a malign ascites. 

 
At the gastric fundus is observed two extrinsic compression

Video Endoscopic Sequence 2 of 10.

 At the gastric fundus is observed two extrinsic compression
In order to relief the ascites a transgastric procedure was performed, first a pre-cut needle was used through an duodenoscope..

Video Endoscopic Sequence 3 of 10.

In order to relief the ascites a transgastric procedure was
performed, first a pre-cut needle was used through an duodenoscope.

After the gastric walls was opened a hydrostatic balloon was used to dilate the small hole.

Video Endoscopic Sequence 4 of 10.

 After the gastric walls was opened a hydrostatic balloon was used to dilate the small hole.

The gastric wall was open using a sphincterotome, the video clip shows the ascites draining across the gastric wall, the Intra-abdominal pressure was relief.

Video Endoscopic Sequence 5 of 10.

The gastric wall was open using a sphincterotome, the video clip shows the ascites draining across the gastric wall, the Intra-abdominal pressure was relief.

 

 
A pulsatile bleeding emerging from the gastric wall.

Video Endoscopic Sequence 6 of 10.

A pulsatile bleeding emerging from the gastric wall.

 
To perform the hemostasis the argon plasma coagulator was used combined with the absolute alcohol.

Video Endoscopic Sequence 7 of 10.

To perform the hemostasis the argon plasma coagulator was used combined with the absolute alcohol.
Injection therapy with absolute alcohol.

Video Endoscopic Sequence 8 of 10.

 Injection therapy with absolute alcohol.
After the gastric wall is open, a transgastric endoscopic access of the peritoneal cavity is seen in the video clip.

Video Endoscopic Sequence 9 of 10.

After the gastric wall is open, a transgastric endoscopic access of the peritoneal cavity is seen in the video clip.

 

 
A Tran gastric periteneoscopy, a part of the peritoneal cavity is observed. This transgastric periteneoscopy, is one of the first performed in a human beings.

Video Endoscopic Sequence 10 of 10.

A transgastric periteneoscopy, a part of the peritoneal
 cavity is observed.

 This transgastric periteneoscopy, is one of the first
 performed in a human beings.

Gastric Carcinoid Tumor. Carcinoids are the most common neuroendocrine tumors. The tumor is derived from primitive stem cells in the gut wall but can be seen in the liver, pancreas, bronchus, and ovaries. In children, most cases occur in the appendix, and most are benign and asymptomatic.

Video Endoscopic Sequence 1 of 8.

Gastric Carcinoid Tumor.

 Carcinoids are the most common neuroendocrine tumors.
 The tumor is derived from primitive stem cells in the gut
 wall but can be seen in the liver, pancreas, bronchus, and
 ovaries. In children, most cases occur in the appendix, and
 most are benign and asymptomatic.
Gastric Carcinoid Tumor. These tumors have a yellow, tan, or gray-brown appearance that can be observed through the intact mucosa. The yellow color is a result of cholesterol and lipid accumulation within the tumor. Tumors can have a polypoid appearance and occasionally can ulcerate.

Video Endoscopic Sequence 2 of 8.

Gastric Carcinoid Tumor.

 These tumors have a yellow, tan, or gray-brown appearance
 that can be observed through the intact mucosa. The yellow
 color is a result of cholesterol and lipid accumulation within
 the tumor. Tumors can have a polypoid appearance and
 occasionally can ulcerate.

 Similar images of Duodenal Carcinoid Tumor are found in
 duodenal miscellaneous chapter.

Gastric Carcinoid Tumor.

Video Endoscopic Sequence 3 of 8.

Gastric Carcinoid Tumor.
Gastric Carcinoid Tumor. Indigo Carmin Stain.

Video Endoscopic Sequence 4 of 8.

Gastric Carcinoid Tumor.

Indigo Carmin Stain.
Cromogranina.

Video Endoscopic Sequence 5 of 8.

  Cromogranina.

 
Gastric Carcinoid Tumor. At low power there is an intramucosal neoplasia.

Video Endoscopic Sequence 6 of 8.

4x.

 Gastric Carcinoid Tumor.

 At low power there is an intramucosal neoplasia.

 
Carcinoid Tumor. At medium power the organoid neoplasia replace the gastric glands. carcinoid tumor.

Video Endoscopic Sequence 7 of 8.

  10x.

Carcinoid Tumor.

 At medium power the organoid neoplasia replace the
 gastric glands. carcinoid tumor.

 
40x. The appendix is the most common site of gut carcinoid tumor, followed by the small intestine, rectum, stomach and ileum. Carcinoid tumor are potentially malignant and the tendency of malignant behavior correlate with the site of origin, the depth of local penetration and the size of the tumor.

Video Endoscopic Sequence 8 of 8.

40x.

 The appendix is the most common site of gut carcinoid
 tumor, followed by the small intestine, rectum, stomach and
 ileum.
 Carcinoid tumor are potentially malignant and the tendency
 of malignant behavior correlate with the site of origin, the
 depth of local penetration and the size of the tumor.

.Gastric Angiodysplastic lesions and argon plasma coagulation treatment. Gastric Angiodysplastic lesions may be encountered at any location, but they tend to occur primarily within the corpus. The tree images and video display ablative therapy with argon plasma coagulation APC.

Video Endoscopic Sequence 1 of 3.

 Gastric Angiodysplastic lesions and argon plasma
 coagulation treatment.

 Gastric Angiodysplastic lesions may be encountered at
 any location, but they tend to occur primarily within the
 corpus. The tree images and video display ablative
 therapy with argon plasma coagulation APC.
 
 

Gastric Angiodysplastic lesions with argon plasma coagulation treatment. Argon plasma coagulation (APC) is a method ofcauterizing the vascular abnormality using a non-contact probe.

Video Endoscopic Sequence 2 of 3.

 Gastric Angiodysplastic lesions with argon plasma
 coagulation treatment.
 Argon plasma coagulation (APC) is a method ofcauterizing
 the vascular abnormality using a non-contact probe.

.Gastric Angiodysplastic lesions with argon plasma coagulation treatment. Argon Plasma Coagulation has been used for more than 10 years in open surgery, laparoscopy and Thoracoscopy, especially for hemostasis of large surface bleeding. It conducts monopolar electrosurgical current to tissue via an ionized argon gas stream (argon plasma).

Video Endoscopic Sequence 3 of 3.

 Gastric Angiodysplastic lesions with argon plasma
 coagulation treatment.
 Argon Plasma Coagulation has been used for more than 10
 years in open surgery, laparoscopy and Thoracoscopy,
 especially for hemostasis of large surface bleeding. It
 conducts monopolar electrosurgical current to tissue via an
 ionized argon gas stream (argon plasma).
 
Foreign body of the stomach that resemble a snake. from time to time the endoscopist get some surprise performing a gastrointestinal endoscopy. 30 year-old woman that had been complaining of severe halitosis that is worse in the morning. The endoscopy was performed in 1990 with the old fiber optics endoscopes (Olympus pre-oes 1T). Therefore the video clips are dark.

Video Endoscopic Sequence 1 of 3.

 Foreign body of the stomach that resemble a snake.
 from time to time the endoscopist get some surprise
 performing a gastrointestinal endoscopy.
 30 year-old woman that had been complaining of severe
 halitosis that is worse in the morning.
 The endoscopy was performed in 1990 with the old
 fiber optics endoscopes (Olympus pre-oes 1T).
 Therefore the video clips are dark.
 
  
We observed the shape that resemble a snake?s head. Most swallowed foreign bodies pass harmlessly through the gastrointestinal (GI) tract. Foreign bodies that damage the GI tract, become lodged, or have associated toxicity must be identified and removed.

Video Endoscopic Sequence 2 of 3.

 We observed the shape that resemble a snake’s head.

 Most swallowed foreign bodies pass harmlessly through
 the gastrointestinal (GI) tract. Foreign bodies that damage
 the GI tract, become lodged, or have associated toxicity
 must be identified and removed.
 

A tooth brush that was found in her stomach. Impacted foreign bodies . A foreign body lodged in the GI tract may cause local inflammation leading to pain, bleeding, scarring, and obstruction, or it may erode through the GI tract. Migration from the esophagus most often leads to mediastinitis but may involve the lower respiratory tract or aorta and create an aortoenteric fistula. Migration through the lower GI tract may cause peritonitis.

Video Endoscopic Sequence 3 of 3.

 A tooth brush that was found in her stomach.

 Impacted foreign bodies.

 A foreign body lodged in the GI tract may cause local
 inflammation leading to pain, bleeding, scarring, and
 obstruction, or it may erode through the GI tract.
 Migration from the esophagus most often leads to
 mediastinitis but may involve the lower respiratory tract or
 aorta and create an aortoenteric fistula. Migration through
 the lower GI tract may cause peritonitis.

Multiple Gastric Leiomiomas. A 20 year-old female that have been under anemia screening. Endoscopically multiples gastric leiomiomas in the posterior wall of the stomach from the antrum to the fundus were found. The patient underwent a subtotal gastrectomy and local resection of leiomiomas of the fundus was performed. Medical literature describes five similar cases reported previously.

Multiple Gastric Leiomiomas.

 A 20 year-old female that have been under anemia
 screening.
 Endoscopically multiples gastric leiomiomas in the
 posterior wall of the stomach from the antrum to the fundus
 were found.
 The patient underwent a subtotal gastrectomy and local
 resection of leiomiomas of the fundus was performed.
 Medical literature describes five similar cases reported
 previously. 

Heterotopic Pancreas with large central hole. Heterotopic Pancreas, due to the hole, as the diameter is not usual in the heterotopic pancreas, some biopsies were obtain from the submucosa which was demonstrated by histology that is a pancreas tissue.

Video Endoscopic Sequence 1 of 6.

Heterotopic Pancreas with large central hole.

 Heterotopic Pancreas, due to the hole, as the diameter is
 not usual in the heterotopic pancreas, some biopsies were
 obtain from the submucosa which was demonstrated by
 histology that is a pancreas tissue.
HecterotopicPancreasx2

Video Endoscopic Sequence 2 of 6.

Heterotopic pancreas is an uncommon but not an exceedingly rare finding. Most of the time, the heterotopic pancreas is usually small (1 cm to 3 cm in size) and located in the antrum. Pancreatic rests are often discovered incidentally

Despite the observation that most cases of heterotopic pancreas do not cause problems, the condition has been reported to lead to symptoms from inflammation, obstruction, or even malignant transformation. Smaller rests have been removed using endoscopic techniques, primarily to secure a diagnosis, as the smaller tumors are often asymptomatic.

The biopsies were obtain from the submucosa , Although malignant transformation has been reported, this appears to be uncommon enough that recommendations on follow up probably should be based on symptoms. With the abuse of alcohol has been reported "gastric pancreatitis."

Video Endoscopic Sequence 3 of 6.

The biopsies were obtain from the submucosa

 Although malignant transformation has been reported, this appears to be uncommon enough that recommendations on follow up probably should be based on symptoms.

 With the abuse of alcohol has been reported "gastric pancreatitis."

 

 
Low power view of gastric heterotopic pancreas.

Video Endoscopic Sequence 4 of 6.

Low power view of gastric heterotopic pancreas
( Acinar pancratic tissue at the left.

Video Endoscopic Sequence 5 of 6.

 Acinar pancratic tissue at the left
High power detail of the heterotopic pancreas.

Video Endoscopic Sequence 6 of 6.

High power detail of the heterotopic pancreas
PancreasAbarrarnte. The majority of the patients are asymptomatic and the lesion is diagnosed incidentally. Heterotopic pancreas is defined as pancreatic tissue outside the boundaries of the pancreas that lacks anatomic and vascular continuity to this organ. Heterotopic pancreas is a relatively infrequent lesion. The pathogenesis of this lesion is unknown; it is believed to arise during embryonic development of the gastrointestinal tract. The normal pancreas is derived from several evaginations originating from the wall of the primitive duodenum. During embryogenesis, if one or more evaginations remain in the wall of the bowel, then it may be carried away from the remainder of the gland by the developing gastrointestinal tract and may give rise to heterotopic pancreas.

Heterotopic Pancreas

 The majority of the patients are asymptomatic and the
 lesion is diagnosed incidentally.

 Heterotopic pancreas is defined as pancreatic tissue
 outside the boundaries of the pancreas that lacks anatomic
 and vascular continuity to this organ. Heterotopic pancreas
 is a relatively infrequent lesion.

 The pathogenesis of this lesion is unknown; it is believed to
 arise during embryonic development of the gastrointestinal
 tract. The normal pancreas is derived from several
 evaginations originating from the wall of the primitive
 duodenum. During embryogenesis, if one or more
 evaginations remain in the wall of the bowel, then it may be
 carried away from the remainder of the gland by the
 developing gastrointestinal tract and may give rise to
 heterotopic pancreas.
Antral Bands. Generally, without clinical implication, but peculiar endoscopic image that resemble a duplicated pylorus.

Antral Bands.

 Generally, without clinical implication, but peculiar
 endoscopic image that resemble a duplicated pylorus.    

Diverticulum in the fundus of the stomach, seen at retroflexion (the shaft of the endoscope is seen descending through the esophagogastric junction at the 12 o'clock position). The diverticulum was an incidental finding in an 72 year-old woman undergoing endoscopy. Gastric diverticula are extremely rare and may be congenital or acquired. When symptomatic, gastric diverticula may cause pain, nausea, dysphagia, and vomiting. Gastric diverticula may also be associated with ectopic mucosa, ulcers, and neoplastic changes.

Diverticulum in the fundus of the stomach

 Diverticulum in the fundus of the stomach, seen at
 retroflexion (the shaft of the endoscope is seen descending
 through the esophagogastric junction at the 12 o'clock
 position). The diverticulum was an incidental finding in an
 72 year-old woman undergoing endoscopy.

 Gastric diverticula are extremely rare and may be congenital or
 acquired. When symptomatic, gastric diverticula may cause pain,
 nausea, dysphagia, and vomiting. Gastric diverticula may also be
 associated with ectopic mucosa, ulcers, and neoplastic changes.
Fundic diverticulum. Diverticulum in the fundus of the stomach, seen at retroflexion.

Fundic diverticulum.

 Diverticulum in the fundus of the stomach, seen at
 retroflexion.

 
Foreign body. Chewed gum in the stomach. Patient swallowed the gum while in the waiting room.

Foreign body.

 Chewed gum in the stomach.
 Patient swallowed the gum while in the waiting room.
 

Pancreatic Heterotopia. Antral nodule with typically central depression and intact overlying, antral mucosa, the submucosa is the most frequent location, both exocrine and endocrine pancreatic tissue may comprise the lesion. The most distinctive heterotopic lesions occurs in the antrum. Ectopic pancreas generally has a typical apical dimple characteristic of this lesion. A rudimentary ductal system may empty into this depression.

Pancreatic Heterotopia.

 Antral nodule with typically central depression and intact
 overlying, antral mucosa, the submucosa is the most
 frequent location, both exocrine and endocrine pancreatic
 tissue may comprise the lesion.
 The most distinctive heterotopic lesions occurs in the
 antrum. 
 Ectopic pancreas generally has a typical apical dimple
 characteristic of this lesion. A rudimentary
 ductal system may empty into this depression.
Antral Diverticula.

Antral Diverticula.
Phytobezoar. Bezoars are concretions in the GI tract that increase in size by the accumulation of nonabsorbable food or fibers. They are uncommon, but when present, they are usually found in patients with altered GI motility or with a history of gastric surgery. A phytobezoar is composed of indigested plant or vegetable fibres, plant skins and leaves. A phytobezoar may develop when foreign material accumulates in the stomach because of indigestibility, poor mastication or disturbances in the gastric emptying mechanism which can occur following surgical procedures such as vagotomy, pyloroplasty or antrectomy. A trichobezoar is secondary to hair ingestion, usually in mentally disturbed patients.

Phytobezoar.

 Bezoars are concretions in the GI tract that increase in size
 by the accumulation of nonabsorbable food or fibers. They
 are uncommon, but when present, they are usually found in
 patients with altered GI motility or with a history of gastric
 surgery.
 A phytobezoar is composed of indigested plant or vegetable
 fibres, plant skins and leaves. A phytobezoar may develop
 when foreign material accumulates in the stomach because
 of indigestibility, poor mastication or disturbances in the
 gastric emptying mechanism which can occur following
 surgical procedures such as vagotomy, pyloroplasty or
 antrectomy. A trichobezoar is secondary to hair ingestion,
 usually in mentally disturbed patients
Watermelon Stomach, longitudinal erythymatous stripes that formed lines within the antrum radiating towards the pylorus resembling the stripes of a watermelon and hence the name gastric antral vascular ectasias (GAVE), or watermelon stomach.

Video Endoscopic Sequence 1 of 7.

Watermelon Stomach

 longitudinal erythymatous stripes that formed lines within
 the antrum radiating towards the pylorus resembling the
 stripes of a watermelon and hence the name gastric antral
 vascular ectasias (GAVE), or watermelon stomach.

 
Treatment of watermelon stomach (GAVE syndrome) with endoscopic argon plasma coagulation (APC). The diagnosis is based on the endoscopic findings. The typical lesions have longitudinal rugal folds traversing the antrum and converging on the pylorus, each containing a visible convoluted column of vessels, the aggregate resembling the stripes of a watermelon. Although these lesions are confined to the antrum in the majority of cases, up to 33% of the patients have proximal gastric involvement typically in the presence of a diaphragmatic hernia. It is important to emphasize, however, that these lesions might be misdiagnosed as gastritis or portal gastropathy and thus delay in treatment could result.

Video Endoscopic Sequence 2 of 7.

 Treatment of watermelon stomach (GAVE syndrome) with
 endoscopic argon plasma coagulation (APC).

 The diagnosis is based on the endoscopic findings. The
 typical lesions have longitudinal rugal folds traversing the
 antrum and converging on the pylorus, each containing a
 visible convoluted column of vessels, the aggregate
 resembling the stripes of a watermelon. Although these
 lesions are confined to the antrum in the majority of cases,
 up to 33% of the patients have proximal gastric
 involvement typically in the presence of a diaphragmatic
 hernia. It is important to emphasize, however, that these
 lesions might be misdiagnosed as gastritis or portal
 gastropathy and thus delay in treatment could result.
Watermelon stomach is an increasingly recognizable cause of persistent acute or occult gastrointestinal bleeding, especially in elderly women. The chief presentation is severe iron deficiency anemia and occult or overt gastrointestinal bleeding. Diagnosis is made on endoscopy by the characteristic appearance of visible watermelon linear stripes in the antrum. Histology is rarely needed to confirm the diagnosis. The importance of this lesion lies in the proper recognition since it is amenable to successful therapeutic interventions, leading to endoscopic healing of the lesion, significant improvement in the anemia and a reduction in the need for blood transfusions.

Video Endoscopic Sequence 3 of 7.

 Watermelon stomach is an increasingly recognizable cause
 of persistent acute or occult gastrointestinal bleeding,
 especially in elderly women. The chief presentation is
 severe iron deficiency anemia and occult or overt
 gastrointestinal bleeding. Diagnosis is made on endoscopy
 by the characteristic appearance of visible watermelon
 linear stripes in the antrum. Histology is rarely needed to
 confirm the diagnosis. The importance of this lesion lies in
 the proper recognition since it is amenable to successful
 therapeutic interventions, leading to endoscopic healing of
 the lesion, significant improvement in the anemia and a
 reduction in the need for blood transfusions.
The argon-plasma-coagulation uses instead of laser energy conduction of electric energy by ionized argon gas (plasma), which produces coagulation necrosis of tissues. The potential advantages of the argon-plasma-coagulation lie in the limited deep penetration, which reduces the risk of perforation and the symmetric spread of the coagulation effects in the surrounding mucosa. These properties make the argon plasma-coagulation a promising tool for the endoscopic therapy of mucosal lesions of the GI-tract. Further attractive is the low cost of the argon-plasma-coagulation equipment compared with laser devices.

Video Endoscopic Sequence 4 of 7.

 The argon-plasma-coagulation uses instead of laser energy
 conduction of electric energy by ionized argon gas (plasma),
 which produces coagulation necrosis of tissues. The
 potential advantages of the argon-plasma-coagulation lie in
 the limited deep penetration, which reduces the risk of
 perforation and the symmetric spread of the coagulation
 effects in the surrounding mucosa. These properties make
 the argon plasma-coagulation a promising tool for the
 endoscopic therapy of mucosal lesions of the GI-tract.
 Further attractive is the low cost of the argon-plasma
 -coagulation equipment compared with laser devices.
The therapeutic options are numerous for this condition and needs to be individualized. The simplest form of therapy is iron supplementation and occasional blood transfusions. When these measures fail, other approaches are warranted, including endoscopic, pharmacologic or surgical therapies.