LONG-TERM FOLLOW-UP OF GASTRIC ANTRAL VASCULAR ECTASIA TREATED BY ARGON PLASMA COAGULATION

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  • アルゴンプラズマ凝固法で治療した胃前庭部毛細血管拡張症の長期経過

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Abstract

Background : Gastric antral vascular ectasia (GAVE) is characterized by diffuse vasodilation mainly affecting the antrum and causes gastrointestinal hemorrhage. Argon plasma coagulation (APC) provides rapid coagulation of a wide region, and thus appears to be more useful than conventional methods for the treatment of extensive lesions with superficial oozing bleeding, such as GAVE. In this study, we evaluated the use of APC for GAVE.Methods : The study subjects were 22 patients with GAVE (10 men and 12 women, mean age 65.8 years, diffuse type [n=19] and watermelon type [n=3]) who developed gastrointestinal hemorrhage (melena, fall in hemoglobin [Hb, by ≤2.0 g/dl], or endoscopy-confirmed bleeding) and treated with APC. Endoscopic treatment was applied weekly, and considered successful if all detectable GAVE lesions were eradicated and the Hb stabilized without further transfusion. Clinical outcome was assessed.Results : The median total number of treatment sessions was 4 (range : 2-9 times), and the median observation period was 23.5 months. The cumulative recurrence-free rate was 49.7 after 1 year, 35.5% after 2 years, and 35.5% after 3 years. The survival rates after treatment were 94.4, 75.8 and 64.9% at 1, 2, and 3 years, respectively. No complications of APC were observed.Conclusion : APC appears to be effective for temporary control of hemorrhage and anemia due to GAVE, but is not always effective over the long-term. For proper management of GAVE, drug therapy, blood transfusion and control of the underlying disease are necessary in addition to achieving hemostasis temporarily by APC.

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