ヒートプローブによる治療が有効であった胃幽門前庭部毛細血管拡張症（watermelon stomach）の1例

Gastric Antral Vascular Ectasia Cured by Heat Coagulation Therapy, Report of a Case

要旨　患者は72歳，男性，動悸，労作時息切れを主訴に来院した．著明な貧血を認め，胃内視鏡検査を施行したところ，幽門輪から前庭部にかけて放射状に拡がる数条の発赤粘膜を認め，生検結果と合わせ胃幽門前庭部毛細血管拡張症（watermelon stomach）と診断した．輪血，鉄剤投与などの保存的療法にヒートプローブによる熱凝固療法を併用し，貧血の改善および病変の消失を認めた．

　A 12-year-old man was admitted to the Wakamatsu municipal hospital, complaining of palpitation and dyspnea on effort for the previous two weeks. Laboratory data showed severe iron deficiency anemia. Upper gastrointestinal endoscopy just after admission showed longitudinal stripes, resembling the stripes of a watermelon, consisting of many red spots from the prepylorus to the proximal antrum. Hypermobility and spontaneous hemorrhage of the gastric antrum could be observed during endoscopy. Histological findings of the biopsy specimen revealed fibromuscular hyperplasia, microvascular ectasia and fibrin thrombi in the lamina propria. Other investigations, including barium follow through and colonoscopy could not detect any other source of gastrointestinal bleeding. In consideration of these findings, we diagnosed this case as gastrointestinal bleeding due to gastric antral vascular ectasia. We treated him by heat coagulation therapy. After the treatment, antral mucosa appeared to be normal endoscopically. In addition, his hemoglobin has subsequently normalized by iron replacement therapy.