ARGON PLASMA COAGULATION FOR GASTRIC ANTRAL VASCULAR ECTASIA: A SINGLE CENTER EXPERIENCE OF 18 PATIENTS

R Enns, L Halparin, J Amar, JS Whittaker, H Chaun

Division of Gastroenterology, Department of Medicine, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia

BACKGROUND: Gastric antral vascular ectasia (GAVE) is an uncommon condition of the stomach which typically presents with gastrointestinal bleeding. Argon plasma coagulation (APC) is a method of cauterizing the vascular abnormality using a non-contact probe. We reviewed our results with APC to determine a) how effective the treatment was b) the complication rate and c) associated patient conditions.

METHODS: All endoscopies between 01/99 to 10/02 were reviewed. Those with a diagnosis of GAVE were retrieved and data regarding patient demographics, presentation, associated conditions, treatment outcomes and complications were recorded. Where there was incomplete information, referring physicians and hospitals were contacted and missing data collected. APC was performed using ERBE generator set at 60 W/flow rate 2.0 L/min using primarily end-firing probes (side-firing and side-firing bevelled probes tested) in patients consciously sedated.

RESULTS: APC was used in 90 patients of whom 20 were initially diagnosed with GAVE. Of these 2 patients were subsequently determined to have hypertensive gastropathy. The other 18 patients were studied in this analysis. The mean age was 67 years (range 45-86) with 13 females/5 males. Patients presented with either transfusion requiring anemia (15) or iron deficient anemia (3). A total of 228 units of prbcs (range 4-60) were transfused in 15 patients prior to initiation of APC. Associated conditions included hepatitis C (4), known cirrhosis (3), collagen vascular disease (5), renal disease (6) and cardiac disease (7). Three patients had previously failed therapy with estrogens (1), bicap cautery (1) and laser (1). Although the body of the stomach was spared by vascular lesions, in 4 patients a ‘collar’ of vascular ectasia was noted at the gastroesophageal (GE) junction. A total of 31 units of prbcs were transfused after initiation of APC; but all patients discontinued bleeding after a total of 42 treatment sessions (range 1-7) with mean follow up 18 months. No complications of therapy occurred.

CONCLUSIONS: Treatment with APC is an effective, safe method to decrease blood loss in patients with GAVE. Comorbid conditions (cardiac, renal, hepatic, collagen vascular disease) are commonly associated with the disorder. Although GAVE primarily involves the antrum, we have noted in some patients vascular ectasia at the GE junction.

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