El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Endoscopic sequence using magnifying endoscope. and aimed dedicated for portal hypertensive gastropathy.

Video Endoscopic Sequence 1 of 5.

Esophageal Varices.

 This endoscopic sequence is taken with magnifying
 endoscope and aimed dedicated for portal hypertensive
 gastropathy.

 

 For more endoscopic details download the video clips by
 clicking on the endoscopic images, wait to be downloaded
 complete then press Alt and Enter; thus you can observe
 the video in full screen.

 All endoscopic images shown in this Atlas contain
 video clips.           

Another variant of portal hypertension is portal hypertensive gastropathy. It affects to 50 percent of patients with portal hypertension. These patients have dilated arterioles and venules (small veins). This abnormality is seen usually in the fundus and cardia of the stomach (approximately 2/3 of the stomach). It is rarely seen in the antrum (last 1/3) of the stomach. It appears to have a snake skin or reticulated appearance.

Video Endoscopic Sequence 2 of 5.

 Endoscopic appearance of portal hypertensive gastropathy
 in a 65-year-old man with cirrhosis. Note the characteristic
 snakeskin appearance of the gastric mucosa.

 Another variant of portal hypertension is portal
 hypertensive gastropathy. It affects to 50 percent of
 patients with portal hypertension. These patients have
 dilated arterioles and venules (small veins). This
 abnormality is seen usually in the fundus and cardia of the
 stomach (approximately 2/3 of the stomach). It is rarely
 seen in the antrum (last 1/3) of the stomach. It appears to
 have a "snake skin " or "reticulated" appearance.
The image and the video clip display a portal hypertensive gastropathy using a magnifying endoscope. Long-term treatment of portal gastropathy and gastric varices is with beta-blockers. They usually take the form of propranolol, a nonselective beta-blocker. These medications allow the pressure within the veins to be decreased, thus reducing the chance that bleeding will occur. Increased incidence of portal hypertensive gastropathy is noted in patients who undergo sclerotherapy for esophageal varices in the past.

 Video Endoscopic Sequence 3 of 5.

 The image and the video clip display a portal
 hypertensive gastropathy using a magnifying endoscope.

 Long-term treatment of portal gastropathy and gastric
 varices is with beta-blockers. They usually take the form of
 propranolol, a nonselective beta-blocker.
 These medications allow the pressure within the veins to be
 decreased, thus reducing the chance that bleeding will
 occur. Increased incidence of portal hypertensive
 gastropathy is noted in patients who undergo sclerotherapy
 for esophageal varices in the past.
Bleeding from portal hypertensive gastropathy accounts for 2.3% of bleeding episodes in cirrhosis. Although serious bleeding from these sources is uncommon.

Video Endoscopic Sequence 4 of 5.

 Bleeding from portal hypertensive gastropathy accounts for
 2.3% of bleeding episodes in cirrhosis. Although serious
 bleeding from these sources is uncommon.
Endoscopic Image of Portal hypertensive gastropathy . Portal hypertensive gastropathy (PHG) is the most common gastric mucosal injury to patients with liver cirrhosis. Portal hypertensive gastropathy (PHG) is the most common gastric mucosal injury to patients with liver cirrhosis. The main histological change is that blood vessels in the mucosa and submucosa become dilated and twisted, and the vessel wall become thickened. In fact, PHG is the major factor in patients with liver cirrhosis who were accompanied with upper gastrointestinal hemorrhage. Therefore, to prevent and cure PHG is particularly important in preventing upper gastrointestinal hemorrhage in patients with liver cirrhosis. Hp infection is closely related to peptic ulcer, chronic gastritis, and gastric cancer; but the relationship between Hp infection and PHG is not clear.

Video Endoscopic Sequence 5 of 5.

 Endoscopic Image of Portal hypertensive gastropathy

 Portal hypertensive gastropathy (PHG) is the most common
 gastric mucosal injury to patients with liver cirrhosis. The
 main histological change is that blood vessels in the mucosa
 and submucosa become dilated and twisted, and the vessel
 wall become thickened. In fact, PHG is the major factor in
 patients with liver cirrhosis who were accompanied with
 upper gastrointestinal hemorrhage. Therefore, to prevent
 and cure PHG is particularly important in preventing upper
 gastrointestinal hemorrhage in patients with liver cirrhosis.
 Hp infection is closely related to peptic ulcer, chronic
 gastritis, and gastric cancer; but the relationship between
 Hp infection and PHG is not clear.
Peptic ulcer has been reported with increased frequency in patients with liver cirrhosis, its prevalence ranging form 5% to 20%

Video Endoscopic Sequence 1 of 5.

 Peptic Ulcer and Liver Cirrhosis.

 This 84 year-old male who was hospitalized due a urosepsis
 and melena one week before underwent a Transurethral
 prostatectomy, no previous medical history of liver
 cirrhosis was know.

 Peptic ulcer has been reported with increased frequency in
 patients with liver cirrhosis, its prevalence ranging form 5%
 to 20%.
Portal Hypertensive Gastropathy. a "snake skin" like gastric mucosal pattern consistent with portal hypertensive gastropathy.

Video Endoscopic Sequence 2 of 5.

Portal Hypertensive Gastropathy.

 A "snake skin" like gastric mucosal pattern consistent with
 portal hypertensive gastropathy.

 
Portal Hypertensive Gastropathy.

Video Endoscopic Sequence 3 of 5.

Portal Hypertensive Gastropathy.

 Portal hypertensive gastropathy is a potential cause of
 bleeding in patients with liver cirrhosis.

 
More images and video clips.

Video Endoscopic Sequence 4 of 5.

More images and video clips.

 
Through the cardias the gastric body is observed with Portal Hypertensive Gastropathy, the video clip shows esophageal varices.

Video Endoscopic Sequence 5 of 5.

 Through the cardias the gastric body is observed with
 portal hypertensive gastropathy, the video clip shows
 esophageal varices.

 
Portal hypertensive gastropathy and gastric antral vascular ectasias (GAVE) are both potential causes of upper GI bleeding. While they can be seen in patients with cirrhosis, it is quite uncommon to find them in the same patient. In portal hypertensive gastropathy, the mucosa is friable and bleeding occurs when the ectatic vessels rupture and manifest as mucosal oozing. The characteristic endoscopic appearance of fine white reticular pattern separating the areas of pinkish mucosa has been described as "snake skin" . The pathogenesis of this disorder involves congestion and hyperemia of the mucosa.. GAVE or watermelon stomach characterized by rows of flat reddish stripes radiating from the pylorus, which can sometimes be confused with portal hypertensive gastropathy. While it can be seen in patients with cirrhosis, most cases are idiopathic. Portal decompression with TIPS does not reduce bleeding caused by GAVE. Antrectomy is reserved as a last option for patients who fail endoscopic therapies. Endoscopic coagulation with heater probe, gold probe or argon plasma coagulator (APC) obliterates the vascular ectasias and reduces the degree of blood loss . More than one session may be needed.

Video Endoscopic Sequence 1 of 6.

 Gastric Antral Vascular Ectasias (GAVE).

 This 54 year-old alcoholic male had melena and stigmata of
 bleeding in an previous endoscopy one week before to
 this one, presented with ascitis and esophageal varices that
 were ligated in three different sessions.

 Portal hypertensive gastropathy and gastric antral vascular
 ectasias (GAVE) are both potential causes of upper GI
 bleeding. While they can be seen in patients with cirrhosis,
 it is quite uncommon to find them in the same patient. In
 portal hypertensive gastropathy, the mucosa is friable and
 bleeding occurs when the ectatic vessels rupture and
 manifest as mucosal oozing. The characteristic endoscopic
 appearance of fine white reticular pattern separating the
 areas of pinkish mucosa has been described as "snake
 skin" . The pathogenesis of this disorder involves
 congestion and hyperemia of the mucosa.

 GAVE or watermelon stomach characterized by rows of
 flat reddish stripes radiating from the pylorus, which
 can sometimes be confused with portal hypertensive
 gastropathy. While it can be seen in patients with cirrhosis,
 most cases are idiopathic. Portal decompression with
 TIPS does not reduce bleeding caused by GAVE.
 Antrectomy is reserved as a last option for patients who
 fail endoscopic therapies. Endoscopic coagulation with
 heater probe, gold probe or argon plasma coagulator (APC)
 obliterates the vascular ectasias and reduces the degree of
 blood loss . More than one session may be needed.

 
There was extensive vascular ectasia in the distal stomach. Background: Gastric Antral Vascular Ectasia or Watermelon stomach is a rare cause of chronic gastrointestinal bleeding, often presenting as a chronic iron deficiency anemia. This condition can be associated with some other diseases such as cirrhosis, autoimmune diseases and others. We report two patients treated with Argon Plasma Coagulation, a 68 years old male with an ethanol related cirrhosis and a 72 years old female with an idiopathic Gastric Antral Vascular Ectasia. The characteristic endoscopic features were mistaken for many years as gastritis. Both patients presented with severe anemia requiring multiple transfusions as treatment. Due to the poor operative risk, both patients were treated with Argon Plasma Coagulation with good results

Video Endoscopic Sequence 2 of 6.

There was extensive vascular ectasia in the distal stomach.

 Background: Gastric Antral Vascular Ectasia or
 Watermelon stomach is a rare cause of chronic
 gastrointestinal bleeding, often presenting as a chronic
 iron deficiency anemia. This condition can be associated
 with some other diseases such as cirrhosis, autoimmune
 diseases and others. We report two patients treated with
 Argon Plasma Coagulation, a 68 years old male with an
 ethanol related cirrhosis and a 72 years old female with an
 idiopathic Gastric Antral Vascular Ectasia. The
 characteristic endoscopic features were mistaken for many
 years as gastritis. Both patients presented with severe
 anemia requiring multiple transfusions as treatment. Due
 to the poor operative risk, both patients were treated with
 Argon Plasma Coagulation with good results.

 
There was extensive vascular ectasia in the distal stomach.

Video Endoscopic Sequence 3 of 6.

There was extensive vascular ectasia in the distal stomach.

 Portal hypertensive gastropathy and gastric antral vascular
 ectasias (GAVE) are both potential causes of upper GI
 bleeding. While they can be seen in patients with cirrhosis,
 it is quite uncommon to find them in the same patient. In
 portal hypertensive gastropathy, the mucosa is friable and
 bleeding occurs when the ectatic vessels rupture and
 manifest as mucosal oozing. The characteristic endoscopic
 appearance of fine white reticular pattern separating the
 areas of pinkish mucosa has been described as "snake
 skin" . The pathogenesis of this disorder involves
 congestion and hyperemia of the mucosa.
Endoscopic coagulation with heater probe, gold probe or argon plasma coagulator (APC) obliterates the vascular ectasias and reduces the degree of blood loss . More than one session may be needed.

Video Endoscopic Sequence 4 of 6.

 Endoscopic coagulation with heater probe, gold probe or
 argon plasma coagulator (APC) obliterates the vascular
 ectasias and reduces the degree of blood loss . More than
 one session may be needed.

 GAVE or watermelon stomach characterized by rows of flat
 reddish stripes radiating from the pylorus, which can
 sometimes be confused with portal hypertensive
 gastropathy. While it can be seen in patients with cirrhosis,
 most cases are idiopathic.

 
Argon plasma coagulation (APC) is a new noncontact electocoagulation technique which has several theoretical advantages over laser.

Video Endoscopic Sequence 5 of 6.

 Argon plasma coagulation (APC) is a new noncontact
 electocoagulation technique which has several theoretical
 advantages over laser.

 
APC is a safe and effective short-term treatment for GAVE. The natural history of the condition is uncertain, and at medium-term follow-up GAVE is found to recur in a substantial number of patients treated with APC. Re-treatment with APC is an option in these patients.

Video Endoscopic Sequence 6 of 6.

The image as well as the video clip display the status post
APC.

 APC is a safe and effective short-term treatment for
 GAVE. The natural history of the condition is uncertain,
 and at medium-term follow-up GAVE is found to recur in a
 substantial number of patients treated with APC.
 Re-treatment with APC is an option in these patients.
Portal Hypertensive Gastropaty 1

Video Endoscopic Sequence 1 of 3.

 
Portal Hypertensive Gastropaty 2

Video Endoscopic Sequence 2 of 3.

 
Portal Hypertensive Gastropaty 3

Video Endoscopic Sequence 3 of 3.