氩等离子体凝固术预防胃肠道血管发育异常所致复发性出血

Argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias.

作者信息

Olmos Jorge Atilio, Marcolongo Mariano, Pogorelsky Valeria, Varela Emilio, Dávolos Jorge Ricardo

机构信息

Gastroenterology Service, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Gascón 450, 1181 Buenos Aires, Argentina.

出版信息

Gastrointest Endosc. 2004 Dec;60(6):881-6. doi: 10.1016/s0016-5107(04)02221-7.

DOI:10.1016/s0016-5107(04)02221-7

PMID:15605001

Abstract

BACKGROUND

Angiodysplasia is a frequent cause of GI bleeding. Argon plasma coagulation has been shown to arrest bleeding, but its efficacy for prevention of recurrent bleeding has not been thoroughly evaluated. This study assessed the effectiveness and the safety of argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias.

METHODS

A total of 60 patients with GI bleeding caused by angiodysplasia were included. The endoscopic intervention was considered successful if there was no further overt bleeding and if the Hb level stabilized. Recurrent bleeding was defined as any detectable bleeding episode (hematemesis, melena, or hematochezia) or a decrease in Hb level.

RESULTS

Overt bleeding was resolved, and the Hb level stabilized without transfusion or supplemental iron therapy in 50 of the 60 patients (83%) at a median follow-up of 18 months (range 6-38 months). In the subgroup of patients with anemia, mean Hb level increased from 8.6 g/dL (range 5.1-12.2 g/dL) to 12 g/dL (range 8.0-15.2 g/dL) ( p < 0.01). The estimated probability of remaining free of recurrent bleeding at 1- and 2-year follow-up was 86%: 95% CI [73%, 93%] and 80%: 95% CI [64%, 89%], respectively. Among 72 procedures, only two were associated with a complication (2.8%).

CONCLUSIONS

Endoscopic argon plasma coagulation is both effective and safe for prevention of recurrent bleeding from GI angiodysplasia.

摘要

背景

血管发育异常是胃肠道出血的常见原因。氩等离子体凝固已被证明可止血，但其预防复发性出血的疗效尚未得到充分评估。本研究评估了氩等离子体凝固预防胃肠道血管发育异常复发性出血的有效性和安全性。

方法

共纳入60例由血管发育异常引起胃肠道出血的患者。如果没有进一步的明显出血且血红蛋白水平稳定，则认为内镜干预成功。复发性出血定义为任何可检测到的出血事件（呕血、黑便或便血）或血红蛋白水平下降。

结果

60例患者中有50例（83%）在中位随访18个月（范围6 - 38个月）时，明显出血得到解决，血红蛋白水平稳定，无需输血或补充铁剂治疗。在贫血患者亚组中，平均血红蛋白水平从8.6 g/dL（范围5.1 - 12.2 g/dL）升至12 g/dL（范围8.0 - 15.2 g/dL）（p < 0.01）。在1年和2年随访时仍无复发性出血的估计概率分别为86%：95%CI[73%，93%]和80%：95%CI[64%，89%]。在72例手术中，只有2例出现并发症（2.8%）。