Endoscopic Argon Plasma Coagulation for the Treatment of Gastric Antral Vascular Ectasia-Related Bleeding in Patients with Liver Cirrhosis

Abstract

Background and Aim: Gastric antral vascular ectasia (GAVE) is a cause of bleeding in patients with liver cirrhosis. Argon plasma coagulation (APC) is the most used endoscopic treatment for GAVE-related bleeding. Treatment failures have been described in patients with haemorrhagic diathesis; post-procedure complications include haemorrhages and septicaemia. The aim of the study was to evaluate efficacy and safety of APC treatment of GAVE-related bleeding in patients with liver cirrhosis. Methods: Patients included were suffering from GAVE-related bleeding and liver cirrhosis. APC treatment was performed until eradication. Resolution of transfusion-dependent anaemia and evaluation of complications were the primary outcomes. Results: 20 patients (16 Child C and 4 Child B) were enrolled and prospectively followed for a mean period of 28 months. GAVE eradication was achieved in all patients after a median of 3 sessions (range 1–10). Resolution of anaemia was achieved in 18 patients. Six patients had relapse of GAVE after a mean of 7.7 months, successfully retreated by APC. Hyperplastic polyps developed in 3 patients causing active bleeding in 2 cases. Five patients had liver transplants and 1 had a relapse of GAVE after transplantation. Conclusion: APC is an effective and safe endoscopic treatment for GAVE in patients with liver cirrhosis.

Case report of gastric antral vascular ectasia (GAVE)

“…Patients without cirrhosis but with GAVE are more likely to have classic WS performance described before, where majority of them are females (71%) with a relatively higher mean age of 73 years. This is similar to the epidemiologic features in human susceptible to cirrhosis and connective-tissue diseases to a certain extent [12,13]. The type with scattered lesions is difficult to distinguish from portal hypertensive gastropathy (PHG) under endoscopy.…”

“…It also applies to patients whose lesions were dispersed and involved a large area of the stomach wall without serious comorbidities (as our cases) [26]. As mentioned above, patients easily got recurrence after drug control and endoscopic treatment, and 2/3 of recurrent people did not have clinical symptoms [12]. Therefore, it is necessary to have a preventive endoscopic treatment and regularly gastroscopic follow-up.…”

“…The next important question was how to cure it. In many cases of GAVE, treatment of underlying medical conditions or stop the caused performance can lead to resolution of GAVE syndrome even complete disappearance of lesions, such as cirrhosis (by liver transplantation) or scleroderma (by immunomodulatory medications) [3,12,16]. Ehab Saad Aldin once reported a patient with gastrointestinal stromal tumors (GISTs) was found to have GAVE after 8 months treatment with Imatinib.…”

Application of various endoscopic techniques in the treatment of GAVE-syndrome

“…Несколько гипотез предполагают роль ме-ханического воздействия, влияние аутоиммунных и гуморальных факторов, гемодинамические рас-стройства [10]. Лечение GAVE-синдрома включает медикаментозную терапию, эндоскопические мето-дики и оперативное пособие [13][14][15]. Лекарствен-ная терапия не играет решающей роли в лечении GAVE-зависимых кровотечений.…”

“…Хирургические методы сопряжены с высоким уровнем осложнений и летальности, поэтому они используются только в случаях, рефрактерных к другим способам лечения [15]. Эндоскопическое лечение, в частности ис-пользование аргоноплазменной коагуляции (АПК), следует считать терапией первой линии для лечения пациентов с GAVE-синдромом, осложненным кро-вотечением [14]. Помимо АПК, предложены лазе-рокоагуляция, склеротерапия, криовоздействие, лигирование резиновыми кольцами, радиочастот-ная абляция [16].…”