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Sickle cell acute chest syndrome — ABIM Board MCQ

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HardHematology/OncologySickle cell acute chest syndromeABIM Board

A 69-year-old woman with systemic sclerosis has recurrent iron-deficiency anemia and transfusion dependence. Endoscopy shows longitudinal erythematous antral stripes radiating from the pylorus without esophageal varices. Which disease-directed treatment is most appropriate?

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Correct answer: C — Perform endoscopic ablation of the antral vascular lesion

The best answer is “Perform endoscopic ablation of the antral vascular lesion”. The watermelon-stomach pattern identifies gastric antral vascular ectasia, which is associated with systemic sclerosis and causes chronic occult blood loss. Endoscopic therapy directly treats the ectatic mucosal vessels; argon plasma coagulation, band ligation, or radiofrequency ablation may be selected according to expertise and recurrence. GAVE is distinct from portal hypertensive gastropathy, so beta blockade and TIPS do not reliably treat it; surgery is reserved for exceptional refractory disease.

Reference: Endoscopic treatment of gastric antral vascular ectasia: https://pmc.ncbi.nlm.nih.gov/articles/PMC8366108/