The beneficial effects of argon plasma coagulation in the management of different types of gastric vascular ectasia lesions in patients admitted for GI hemorrhage

Received 30 July 2007; accepted 4 February 2008. published online 23 April 2008.

Refers to article:

CME Activity: Continuing Medical Examination Exam: September 2008
Todd H. Baron, Brenna C. Bounds, Robert Sedlack, Allan P. Weston, G.S. Raju, George Triadafilopoulos
Gastrointestinal Endoscopy
September 2008 (Vol. 68, Issue 3, Pages 531-534)
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Background

Despite different forms of treatment, few studies have been performed on the outcome and prognosis of patients admitted to the hospital because of gastric vascular ectasia (GVE) and upper-GI bleeding (UGIB). There is also little knowledge on the efficacy of argon plasma coagulation (APC) in different subgroups of GVE lesions.

Objective

This study was designed to evaluate the efficacy of APC in patients admitted to the hospital with UGIB because of GVE.

Design

Prospective evaluation of consecutive cases of UGIB because of GVE.

Setting

Tertiary and university-affiliated hospital.

Patients and Interventions

Twenty-nine patients were included and divided into 3 subgroups: focal vascular ectasia lesions (FVE) (n = 10), portal hypertensive gastropathy (PHG) (n = 11), and gastric antral vascular ectasia (GAVE) (n = 8). Patients were followed at 3 months and every 6 months thereafter during a mean of 23.1 months (range 18-37 months). All patients received intensive APC treatment that was repeated, depending on the endoscopic appearance or clinical evaluation.

Results

The overall success of APC treatment was 86%, with only one recurrence of UGIB during the follow-up period. The number of APC sessions was 1.2, 2.2, and 2.3, in each subgroup (not significant), with a total number of sessions of 1.9 ± 1.3. Treatment success was 90% in the FVE group, 81% in the PHG group, and 87.5% in the GAVE group (NS). The rise in hematocrit from baseline values in the overall group and in each subgroup was significant (P > .01).

Limitations

A single-center study and small sample.

Conclusions

Endoscopic thermal ablation with APC is effective in managing UGIB and in reducing transfusion requirements in patients admitted for GI hemorrhage because of different endoscopic types of GVE.

Barcelona, Spain

Current affiliations: Endoscopy Unit (S.H., J.M.B., J.L., A.G., M.P., G.F.-E., F.M., A.M., A. Cárdenas), Gastroenterology Department (A. Castells), Institut de Malalties Digestives i Metabòliques, Hospital Clinic, University of Barcelona, Catalonia, Spain

Reprint requests: Josep M. Bordas MD, Endoscopy Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clinic, Villarroel, 170 (Esc 3 pis 2), 08036 Barcelona, Spain.

See CME section; p. 532.

PII: S0016-5107(08)00211-3

doi:10.1016/j.gie.2008.02.009

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