PMC9575171_01
Upper Gastrointestinal endoscopy images showing multiple telangiectasia in the stomach (black arrows) and ulcer located in the second part of the duodenum (green arrow).
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F1
The patient was further investigated in the gastroenterology unit with EGD showing multiple arteriovenous (AV) malformations in the gastroesophageal junction, gastric fundus, and pylorus and the second part of the duodenum with active bleeding and ulcerations for which argon plasma coagulation (APC) was done (Figure 1).
Colonoscopy images showing the presence of melanic stools in the cecum, ascending colon, and transverse colon (blue arrow), suggesting upper gastrointestinal bleed. The image also shows multiple telangiectasias in the rectosigmoid region (green arrow).
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F2
In addition, a colonoscopy revealed AV malformations in the rectosigmoid region for which APC was done (Figure 2).
The trend in hemoglobin levels before and after bevacizumab initiation. The patient received multiple Packed RBC transfusions, and underwent multiple endoscopic argon plasma coagulation (APC) and an emergency laparotomy (for extensive GI bleed) to maintain hemoglobin level before bevacizumab commencement. While after initiating bevacizumab, he became transfusion independent and had a progressive uptrend in his hemoglobin level from 6.4 to 12 mg/dL at 8 months follow-up.
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F3
The patient was continuously dropping his hemoglobin levels requiring multiple transfusions (Figure 3) and was refractory to multiple treatments (APC, steroids, and bowel resection of dilated vessels). The patient was subsequently started on bevacizumab and showed dramatic improvement (Figure 3) both symptomatically and hematologically, requiring no further transfusions. The patient has been closely followed since then and monitored with monthly CBC (complete blood count), as shown in Figure 3. At 8 months follow-up (September 2022), his hemoglobin was 12 mg/dL (Figure 3).