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

Abstract

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.

• Authors: Samuel Herrera, Josep M Bordas, Josep Llach, Angels Ginès, Maria Pellisé, Glòria Fernández-Esparrach, Fernando Mondelo, Alfredo Mata, Andres Cárdenas, Antoni Castells
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 68 Issue 3 Pg. 440-6 (Sep 2008) ISSN: 1097-6779 [Electronic] United States
• PMID: 18423466 (Publication Type: Comparative Study, Evaluation Study, Journal Article)

Chemical References

• Argon

Topics

• Acute Disease
• Aged
• Aged, 80 and over
• Argon (therapeutic use)
• Education, Medical, Continuing
• Emergency Service, Hospital
• Female
• Follow-Up Studies
• Gastric Antral Vascular Ectasia (complications, pathology, surgery)
• Gastric Mucosa (pathology)
• Gastrointestinal Hemorrhage (etiology, pathology, surgery)
• Gastroscopy
• Humans
• Laser Coagulation (adverse effects, methods)
• Male
• Middle Aged
• Probability
• Prospective Studies
• Risk Assessment
• Sensitivity and Specificity
• Severity of Illness Index
• Spain
• Treatment Outcome