Secuencia Video Endoscópica 1 de 5.

Várices Esofágicas.

Esta secuencia endoscópica ha sido obtenida con endoscopio con magnificación y es dedicado más a la gastropatia portal hipertensiva.

Para mayores detalles descargar los videos presionado sobre las imágenes endoscópicas.

Todas las imágenes endoscópicas de este atlas llevan un video pueden descargarse, almacenarse en la computadora y pueden ser usadas en presentaciones científicas.

Secuencia Video Endoscópica 2 de 5.

Otra variante de la hipertensión porta es la gastropatía porta hipertensiva esta presente en 50% de los pacientes.

Las arteriolas y las venulas están dilatadas en estos pacientes. Esta anormalidad esta usualmente presente en el fondo y en el cardias, es encontrada rara vez en el antro.

El aspecto que tiene es de piel de culebra o apariencia reticulada.

Secuencia Video Endoscópica 3 de 5.

En la imagen y en el video se observa gastropatía hipertensiva porta usando endoscopio con magnificación.
Tratamiento a largo plazo de la gastropatia porta con betabloqueadores. Estos medicamentos bajan la presión dentro de las venulas, así reduce el chance de sangramiento.

Aumento de la incidencia de la gastropatía hipertensiva es observada en pacientes que con anterioridad se les esclerosaron las várices.

Secuencia Video Endoscópica 4 de 5.

Imagen en piel de culebra.

Sangramiento de una gastropatía hipertensiva porta se estima en un 2.3% de los sangramientos en pacientes cirróticos, aunque sangramientos serios de esta patología es rara.

Secuencia Video Endoscópica 5 de 5.

Gastropatía hipertensiva portal, es la lesión más común de la mucosa gástrica en pacientes cirróticos.

Los principales cambios histológicos son debidos a que los vasos en la mucosa y sub mucosa están dilatados y torcidos, las paredes de los vasos están engrosadas.

Secuencia Videoendoscópica 1 de 5.

Ulcera péptica y cirrosis.

Paciente masculino de 84 años, fue hospitalizado por urosepsis y melenas, una semana antes, había sido sometido a una prostatectomía transuretral.
Antes de la endoscopia no había sospecha de cirrosis.

Se ha reportado un aumento en la frecuencia de úlcera péptica en pacientes con cirrosis, con una prevalencia de 5 a 20%.

Secuencia Videoendoscópica 2 de 5.

Gastropatía por hipertensión portal.

Un patrón de mucosa gástrica como “piel de serpiente” consistente con una gastropatía por hipertensión portal.

Secuencia Videoendoscópica 3 de 5.

Gastropatía por hipertensión portal.

La gastropatía por hipertensión portal es una potencial causa de sangramiento en pacientes con cirrosis.

Secuencia Videoendoscópica 4 de 5.

 Más imágenes y videos.

Secuencia Videoendoscópica 5 de 5.

A través del cardias, puede observarse el cuerpo gástrico con gastropatía por hipertensión portal. En el video se observan várices esofágicas.

Video Endoscopic Sequence 1 of 6.

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.

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.

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.

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.

Video Endoscopic Sequence 5 of 6.

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

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.

Secuencia Video Endoscópica 1 de 3.

Secuencia Video Endoscópica 2 de 3.

Secuencia Video Endoscópica 3 de 3.