ARGON PLASMA COAGULATION FOR GASTRIC ANTRAL VASCULAR ECTASIA: A SINGLE CENTER EXPERIENCE OF 30 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 or anemia. 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: Thirty-two patients with definitively proven GAVE were included in the analysis. The mean age was 70 years (range 45-86) with 23 females/9 males. Patients presented with either transfusion requiring anemia (28) or iron deficient anemia (4). A total of 389 units of prbcs (range 4-60, mean 14 units/pt) were transfused prior to initiation of APC. Associated conditions included hepatitis C (5), cirrhosis (6), collagen vascular disease (7), renal disease (6) and cardiac disease (11). Five patients had previously failed therapy with estrogens (2), bicap cautery (2) and laser (1). Although the body of the stomach was spared by vascular lesions, in 19 patients a 'collar' of vascular ectasia was noted at the gastroesophageal (GE) junction. A total of 57 units of prbcs were transfused after APC initiation. Therapy included a total of 78 treatment sessions (range 1-7) with mean follow up 24 months. Complications included gastric ulcer (1) and one patient required admission for vomiting after each of three treatments. No patients required other therapy (i.e. surgery).
CONCLUSIONS: Treatment with APC is an effective, safe method to decrease blood loss in patients with GAVE. Multiple comorbid conditions coexist. Although GAVE primarily involves the antrum, in most patients vascular ectasia also occur at the GE junction which may support a motility/pressure pathogenesis hypothesis.