Yusoff I, Brennan F, Ormonde D, Laurence B
Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia.
Endoscopy. 2002 May;34(5):407-10. doi: 10.1055/s-2002-25287.
Watermelon stomach or gastric antral vascular ectasia (GAVE) is a rare but well-recognized cause of gastrointestinal blood loss, which typically affects elderly women. Historically patients were treated with antrectomy but this has been largely replaced by endoscopic therapy such as Nd:YAG laser. Argon plasma coagulation (APC) is a new noncontact electocoagulation technique which has several theoretical advantages over laser. The objective of this study was to assess the efficacy of APC in treating GAVE.
We retrospectively reviewed the case-records of five patients (four women, one man) with iron deficiency anaemia or gastrointestinal blood loss due to GAVE who were treated with APC and for whom a follow-up of more than 12 months was available. Four patients were transfusion-dependent. Their mean age was 71 years (range 58 - 83). The mode of presentation, number of treatment sessions, response to therapy and recurrence (if any) were recorded.
A mean of 2.6 treatment sessions per patient were required. All patients had an endoscopically observed response to therapy and all patients had a sustained rise in hemoglobin level after treatment. Transfusion dependence ceased in all patients. After a mean follow-up of 20 months GAVE recurred in two patients (40 %). Both patients responded to further APC treatment. No major complications were recorded.
APC is a safe and effective short-term treatment for GAVE. The natural history of the condition is uncertain, and at medium-term follow-up GAVE is found to recur in a substantial number of patients treated with APC. Re-treatment with APC is an option in these patients.
西瓜胃或胃窦血管扩张症（GAVE）是胃肠道失血的一种罕见但已被充分认识的病因，典型地影响老年女性。过去，患者接受胃窦切除术治疗，但这种方法在很大程度上已被诸如Nd:YAG激光等内镜治疗所取代。氩离子凝固术（APC）是一种新的非接触式电凝技术，与激光相比具有若干理论优势。本研究的目的是评估APC治疗GAVE的疗效。
我们回顾性分析了5例因GAVE导致缺铁性贫血或胃肠道失血的患者（4例女性，1例男性）的病例记录，这些患者接受了APC治疗且有超过12个月的随访资料。4例患者依赖输血。他们的平均年龄为71岁（范围58 - 83岁）。记录了患者的临床表现方式、治疗次数、治疗反应及复发情况（如有）。
每位患者平均需要2.6次治疗。所有患者在内镜下均观察到治疗反应，且所有患者治疗后血红蛋白水平持续升高。所有患者均不再依赖输血。平均随访20个月后，2例患者（40%）出现GAVE复发。这2例患者对进一步的APC治疗均有反应。未记录到重大并发症。
APC是治疗GAVE的一种安全有效的短期治疗方法。该病的自然病程尚不确定，在中期随访中发现，大量接受APC治疗的患者会出现GAVE复发。对这些患者可选择再次进行APC治疗。
