We successfully used
argon plasma coagulation (APC) to treat two cases of dialysis patients with hemorrhagic gastric
angiodysplasia. Gastric
angiodysplasia is recognized as an important cause of gastrointestinal
bleeding. Angiodysplastic lesion confined to the gastric antrum was first described in 1953 and named
gastric antral vascular ectasia (GAVE). The condition is characterized as submucosal capillary dilatation and fibromuscular
hyperplasia. The typical finding of GAVE is the so-called
watermelon stomach, attributable to vasodilatation. In case 1, a 69-year-old man was introduced
continuous ambulatory peritoneal dialysis (
CAPD) in July 1997 because of
chronic renal failure due to
nephrosclerosis. He was hospitalized for severe
anemia in December 1997. Gastrointestinal fiberscopy (GIF) showed oozing in the antrum, and
gastritis and
esophagitis with sliding
hernia.
Famotidine was started and recombinant human
erythropoietin (rHuEPO) was used for
anemia. However, the severe
anemia did not improve. The patient was hospitalized again for severe
anemia and
hematemesis. Another GIF showed typical
watermelon stomach, which corresponded with GAVE. An APC was performed without complications. Three months later, the
anemia was improved, and the dose of rHuEPO was reduced. In case 2, a 57-year-old woman was introduced to
hemodialysis in 1998 for
uremia due to
nephrosclerosis. In October 2000, she was hospitalized for rHuEPO-resistant
anemia. A GIF showed oozing in the antrum with diffuse vasodilation in the antrum; GAVE was diagnosed. An APC was carried out without complications. Three months later,
anemia was improved. Recently, gastric
angiodysplasia was reported to be an important complication in dialysis patients and was recognized as an important cause of rHuEPO-resistant
anemia.
Argon plasma coagulation is an effective treatment for gastric
angiodysplasia in patients on dialysis.