Tamari Hirosato, Oka Shiro, Tanaka Shinji, Hiyama Yuichi, Ninomiya Yuki, Kotachi Takahiro, Boda Tomoyuki, Yuge Ryo, Urabe Yuji, Kitadai Yasuhiko, Chayama Kazuaki
Department of Endoscopy Hiroshima University Hospital Hiroshima Japan.
Department of Gastroenterology and Metabolism Hiroshima University Hospital Hiroshima Japan.
JGH Open. 2021 Mar 6;5(4):465-469. doi: 10.1002/jgh3.12517. eCollection 2021 Apr.
Gastric antral vascular ectasia (GAVE) causes gastrointestinal bleeding. The initial treatment for GAVE bleeding is endoscopic hemostasis, and currently, the most performed technique to achieve hemostasis is argon plasma coagulation (APC). However, APC is associated with a high recurrence rate. To overcome this limitation, we examined the outcomes of the combination therapy of APC and polidocanol injection (PDI) for treating GAVE.
We retrospectively analyzed the outcomes of 15 consecutive GAVE patients treated with PDI + APC at Hiroshima University Hospital between November 2011 and September 2019 with respect to clinical characteristics, hemostatic efficacy, complications related to treatment, and recurrence rate.
The mean age of patients (4 men and 11 women) was 74 ± 8.4 years. Patients had comorbidities of liver cirrhosis (seven patients, 47%), chronic renal failure (seven patients, 47%), and autoimmune diseases (seven patients, 47%). Endoscopic hemostasis with PDI + APC was performed in all patients ( = 15). The mean number of PDIs attempted to stop bleeding was 1.5 ± 0.8 (1-4), and the mean number of APCs attempted was 2.1 ± 1.2 (1-5). Complications related to treatment occurred in two patients (14%): ulceration in one patient and hematoma in another patient, both of whom were treated conservatively. Two patients (13%) had recurrences during the follow-up period (average period, 42 months). Both were cured with additional treatment of PDI only.
The combination therapy of PDI and APC is effective for GAVE with a low recurrence rate.
胃窦血管扩张症（GAVE）可导致胃肠道出血。GAVE出血的初始治疗方法是内镜止血，目前，实现止血最常用的技术是氩等离子体凝固术（APC）。然而，APC的复发率较高。为克服这一局限性，我们研究了APC联合聚多卡醇注射（PDI）治疗GAVE的效果。
我们回顾性分析了2011年11月至2019年9月在广岛大学医院接受PDI + APC治疗的15例连续性GAVE患者的临床特征、止血效果、治疗相关并发症及复发率。
患者平均年龄为74±8.4岁（4例男性，11例女性）。患者合并肝硬化（7例，47%）、慢性肾衰竭（7例，47%）和自身免疫性疾病（7例，47%）。所有患者（n = 15）均接受了PDI + APC内镜止血治疗。试图止血的PDI平均次数为1.5±0.8（1 - 4次），APC平均次数为2.1±1.2（1 - 5次）。两名患者（14%）出现治疗相关并发症：1例患者出现溃疡，另1例患者出现血肿，二者均接受保守治疗。2例患者（13%）在随访期间复发（平均随访期42个月）。二者均仅通过额外的PDI治疗得以治愈。
PDI与APC联合治疗GAVE有效，复发率低。
