Gastric antral vascular ectasia in a pediatric patient with neuroblastoma who underwent tandem stem cell transplantation

Authors: Yumiko Sugishita, Shohei Yamamoto, Ryota Kaneko, Naoko Okamoto, Masaya Koganesawa, Sachiko Fujita, Kosuke Akiyama, Ryosuke Matsuno, Daisuke Toyama, Keiichi Isoyama

first published: December, 21. 2018

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Vol.2 Issue 1 No.2 2019 / BCT-2018-007


Gastric antral vascular ectasia (GAVE) is an angiodysplastic disorder, which causes severe and prolonged gastric bleeding. Although GAVE has been described in adult patients treated with hematopoietic stem cell transplantation (HSCT), a few cases involving pediatric patients have also been reported. A 5-year-old boy with neuroblastoma (NB) developed severe hematemesis after undergoing tandem HSCT, i.e. autologous peripheral blood stem cell transplantation (auto-PBSCT), followed by allogeneic cord blood transplantation (allo-CBT). The patient suffered oral feeding difficulties because of the effects of chemotherapy and an unbalanced diet. Intravenous Busulfan (ivBU) was used as a conditioning regimen for the auto-PBSCT. The diagnosis of GAVE was made based on endoscopy of the upper gastrointestinal tract on day 31 after the allo-CBT. Argon plasma coagulation (APC) was performed twice, and the complete resolution of GAVE was confirmed by an endoscopic re-evaluation, conducted on day 87. GAVE in this case might have been associated with ivBU treatment. Atrophy of the gastric mucosa due to loss of appetite might also have contributed to GAVE. NB was treated using high-doses of alkylating agents, such as BU. Such treatment can cause significant mucositis of the oral cavity as well as vascular lesions and is associated with GAVE. Therefore, GAVE should be considered when gastrointestinal bleeding occurs in NB patients treated with HSCT. APC might be effective against HSCT-GAVE.

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Yumiko Sugishita1, Shohei Yamamoto1, Ryota Kaneko1, Naoko Okamoto1, Masaya Koganesawa1, Sachio Fujita1, Kosuke Akiyama1, Ryosuke Matsuno1, Daisuke Toyama1, Keiichi Isoyama1

1: Department of Pediatrics, Showa University Fujigaoka Hospital, Kanagawa, Japan



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