Cho Sarah, Zanati Simon, Yong Elaine, Cirocco Maria, Kandel Gabor, Kortan Paul, May Gary, Marcon Norman
The Centre for Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Gastrointest Endosc. 2008 Nov;68(5):895-902. doi: 10.1016/j.gie.2008.03.1109. Epub 2008 Jul 21.
Gastric antral vascular ectasia (GAVE) is an uncommon but clinically significant cause of chronic GI bleeding.
To assess the efficacy and safety of cryotherapy for endoscopic treatment of GAVE.
Patients received 3 sessions of endoscopic cryotherapy at 3-week to 6-week intervals and had a follow-up endoscopy 4 weeks thereafter. They were followed prospectively in terms of clinical and endoscopic response.
Tertiary-care center, between October 2004 and April 2006.
The patients were 43 to 89 years of age, with a diagnosis of GAVE and documented iron deficiency anemia. Eight patients had a history of overt GI bleeding. Eight patients (67%) had previously been treated with argon plasma coagulation (APC) (median 6 sessions, range 1-10 sessions) and failed to respond or had a recurrence.
Twelve patients were enrolled. Six patients (50%) had a complete response, and 6 patients had a partial response. The mean number of units of blood transfused in the period of 3 months before cryotherapy and during the period of follow-up of 3 months was 4.6 and 1.7 units, respectively. An increased mean Hb level, from 9.9 to 11.3 g/dL, was noted. The average duration of the cryotherapy was 5 minutes (range 1-15 minutes). In 32 of 36 cryotherapy treatment sessions performed (89%), it was technically possible to treat more than 90% of GAVE lesions. There were no immediate cryotherapy-related complications, and none of the patients required admission after the procedure.
A pilot study from a single center.
Endoscopic cryotherapy is a safe and effective treatment for GAVE. It appears to be effective, even for GAVE refractory to APC therapy. Optimal cryogen, delivery device, and treatment protocols are yet to be determined.
胃窦血管扩张症（GAVE）是慢性胃肠道出血的一个不常见但具有临床意义的病因。
评估冷冻疗法内镜治疗GAVE的疗效和安全性。
患者每隔3至6周接受3次内镜冷冻治疗，此后4周进行随访内镜检查。对患者的临床和内镜反应进行前瞻性随访。
2004年10月至2006年4月期间的三级医疗中心。
患者年龄在43至89岁之间，诊断为GAVE且有缺铁性贫血记录。8例患者有明显胃肠道出血史。8例患者（67%）此前接受过氩离子凝固术（APC）治疗（中位数6次，范围1至10次），但无反应或复发。
12例患者入组。6例患者（50%）完全缓解，6例患者部分缓解。冷冻治疗前3个月和随访3个月期间平均输血量分别为4.6单位和1.7单位。血红蛋白水平平均从9.9g/dL升至11.3g/dL。冷冻治疗平均持续时间为5分钟（范围1至15分钟）。在进行的36次冷冻治疗中，32次（89%）在技术上能够治疗超过90%的GAVE病变。没有与冷冻治疗直接相关的并发症，术后无患者需要住院。
单中心的初步研究。
内镜冷冻治疗是治疗GAVE的一种安全有效的方法。即使对APC治疗无效的GAVE，它似乎也有效。最佳冷冻剂、输送装置和治疗方案尚待确定。
