Comparison of argon plasma coagulation in management of upper gastrointestinal angiodysplasia and gastric antral vascular ectasia hemorrhage

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dc.contributor.authorChiu, Y.C.
dc.contributor.authorLu, L.S.
dc.contributor.authorWu, K.L.
dc.contributor.authorTam, W.
dc.contributor.authorHu, M.L.
dc.contributor.authorTai, W.C.
dc.contributor.authorChiu, K.W.
dc.contributor.authorChuah, S.K.
dc.date.issued2012
dc.description.abstractBACKGROUND: Vascular ectasias, including gastric antral vascular ectasia (GAVE) and angiodysplasia, are increasingly recognized as important sources of gastrointestinal bleeding. This study investigated and compared the efficacies and outcomes of treatment of upper gastrointestinal (UGI) angiodysplasia and GAVE hemorrhage by endoscopic argon plasma coagulation (APC). METHODS: From January 2006 to December 2009, 46 patients diagnosed with upper GI bleeding caused by angiodysplasia or GAVE at a tertiary hospital were recruited into this study. They included 26 males and 20 females with an average age of 65.6 years (range, 45-90 years). All patients underwent APC for hemostasis during an endoscopic procedure. Parameters such as underlying co-morbidities, number of endoscopic treatment sessions, recurrent bleeding, and clinical outcomes during follow-up were analyzed. RESULTS: The 46 patients with UGI vascular ectasia hemorrhage included 27 patients with angiodysplasia and 19 with GAVE. The patients with angiodysplasia were older than those with GAVE (71.6 ± 10.2 years versus 61.8 ± 11.9 years, P = 0.005). More GAVE patients than angiodysplasia patients had co-existing liver cirrhosis (63.2% versus 25.9%, P = 0.012). The patients with GAVE had a higher rate of recurrent bleeding (78.9% versus 7.4%, P < 0.001) and required more treatment sessions to achieve complete hemostasis (2.4 ± 1.4 versus 1.1 ± 0.1, P < 0.001) than those with angiodysplasia. Univariate analysis demonstrated that age greater than 60 years (odds ratio (OR) = 8.929, P = 0.003), GAVE (OR = 0.021, P < 0.001), and previous radiation therapy (OR = 11.667, P = 0.032) were associated with higher rates of recurrent bleeding. Further multivariate analysis revealed that GAVE was the only independent risk factor for recurrent bleeding after APC treatment (OR = 0.027, P < 0.001). CONCLUSION: Endoscopic hemostasis with APC is a safe treatment modality for both angiodysplasia and vascular ectasia bleeding. The efficacy of APC treatment is greater for angiodysplasia than for vascular ectasia bleeding. GAVE patients have a higher recurrent bleeding rate and may require multiple treatment sessions for sustained hemostasis.
dc.description.statementofresponsibilityYi-Chun Chiu, Lung-Sheng Lu, Keng-Liang Wu, William Tam, Ming-Luen Hu, Wei-Chen Tai, King-Wah Chiu and Seng-Kee Chuah
dc.identifier.citationBMC Gastroenterology, 2012; 12(1):67-67
dc.identifier.doi10.1186/1471-230X-12-67
dc.identifier.issn1471-230X
dc.identifier.issn1471-230X
dc.identifier.urihttp://hdl.handle.net/2440/121291
dc.language.isoen
dc.publisherSpringer Nature
dc.rights© 2012 Chiu et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.source.urihttps://doi.org/10.1186/1471-230x-12-67
dc.subjectEndoscopic argon plasma coagulation; angiodysplasia; gastric antral vascular ectasia
dc.titleComparison of argon plasma coagulation in management of upper gastrointestinal angiodysplasia and gastric antral vascular ectasia hemorrhage
dc.typeJournal article
pubs.publication-statusPublished

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