S4811 Short-Term Response to Bevacizumab in a Patient With Refractory Gastric Antral Vascular Ectasia

Introduction: Gastric antral vascular ectasia (GAVE) is a cause of upper gastrointestinal bleeding (UGIB)— treatment modalities include endoscopic, medical, and surgical interventions. Bevacizumab has been explored as a treatment for refractory GAVE. Case Description/Methods: A 69-year-old man with non-alcoholic steatohepatitis presented with chronic UGIB, resulting in transfusion-dependent iron deficiency anemia (TD-IDA). Endoscopy revealed GAVE and small bowel telangiectasia. The patient underwent endoscopic interventions, initiated tranexamic acid, which was discontinued due to intolerance, and received intravenous (IV) iron. Given his persistent anemia bevacizumab (Avastin) 5 mg/kg was initiated. It was administered every 2 weeks for a total of 8 doses. This regimen aligns with protocols used in the treatment of hereditary hemorrhagic telangiectasia (HHT) and small bowel angiodysplasia (SBA). Once his hemoglobin stabilized, the dosing interval was extended to every 4 weeks. A trial of stopping IV iron led to transfusion need; IV iron and bevacizumab every 2 weeks were resumed. Bevacizumab was discontinued after months due to inadequate response. He was subsequently hospitalized for the ongoing GIB. Discussion: GAVE is a rare cause of UGIB, leading to TD-IDA, particularly in the elderly, and accounts for up to 4% of nonvariceal UGIB. GAVE presents with acute or chronic bleeding and is challenging to diagnose due to its rarity. It is associated with liver, kidney, cardiac, and autoimmune diseases, complicating diagnosis and management. Medical therapies include corticosteroids, estrogen-progesterone, octreotide, and tranexamic acid. Endoscopic options like band ligation and radiofrequency ablation are used but have high recurrence rates. Surgery is reserved for refractory cases and includes gastrectomy or gastroesophagectomy. Bevacizumab, an anti-vascular endothelial growth factor (VEGF) monoclonal antibody, blocks VEGF receptors, inhibiting angiogenesis and reducing blood supply. It has proven effective in reducing bleeding and transfusion needs in conditions like HHT and SBA. A study by Albitar et al. showed reduced need for endoscopic interventions and transfusions in refractory GIB cases due to GAVE and SBA after bevacizumab treatment. This case illustrates the potential efficacy of bevacizumab in treating refractory GAVE, resulting in clinical improvement and transfusion independence, although the response was not sustained. Studies are needed to establish long-term efficacy and safety in such cases.