Duodenal Vascular Ectasia: Rare Cause of Gastrointestinal Bleeding

Duodenal vascular ectasia (DVE) is a rare but important cause of upper gastrointestinal bleeding, particularly in patients with chronic liver disease. Gastric antral vascular ectasia (GAVE) is a more commonly recognized vascular lesion associated with cirrhosis; however, vascular ectasia involving the duodenum is infrequently reported and may pose diagnostic and therapeutic challenges. We report a case of a cirrhotic patient presenting with recurrent upper gastrointestinal bleeding manifested as melena and progressive anemia. Initial evaluation suggested variceal bleeding; however, endoscopic examination revealed the presence of GAVE along with vascular ectasia involving the duodenal bulb and extending into the third part of the duodenum. Histopathological examination of duodenal biopsies demonstrated dilated vascular channels within the lamina propria, consistent with duodenal vascular ectasia. Endoscopic management was initially directed toward GAVE using argon plasma coagulation (APC). Due to persistent anemia and recurrent bleeding, APC therapy was subsequently applied to the duodenal vascular lesions with careful technique to minimize the risk of perforation. Hemostasis was successfully achieved without complications, and the patient showed sustained clinical improvement with stabilization of hemoglobin levels and no further transfusion requirement during follow-up. This case highlights duodenal vascular ectasia as a potential source of gastrointestinal bleeding in cirrhotic patients and demonstrates that argon plasma coagulation can be a safe and effective therapeutic modality when applied cautiously.