3388 Endoscopic treatment with argon plasma coagulation for portal hypertensive gastropathy.

Abstract

Portal hypertensive gastropathy (PHG) is a rare but relevant cause of gastrointestinal bleeding for which few options of medical therapy are available. Argon plasma coagulation (APC) is an endoscopic method of non-contact electrocoagulation which can be delivered by tangential application and has only limited deep of penetration. Subsequently, APC appeal for treating widespread vascular disorders such as PHG. The aim of this study was to assess the efficacy of APC for the treatment of chronic bleeding from PHG which did not respond to the pharmacological therapy of portal hypertension. METHODS: 9 patients with cirrhosis (Pugh class A/B in 3/6 and posthepatitic etiology in 6) were included. All had PHG with recurrent bleeding despite iron therapy plus isosorbide mononitrate alone (in 4 cases with intolerance to β-blockers) or combined with nadolol (3 cases) while 2 patients had no previous treatment. APC was delivered by multiple and brief pulses applied over wide areas of visible angioectasias. Sessions were performed every 2 to 3 weeks. PHG was diffuse in 4 cases and mainly antral in 5. RESULTS: a median of 6 sessions of APC were performed (range 4 to 12) during a mean period of 6±4 months. The mean follow-up was of 28±12 months. Hemoglobin value significantly improved after APC (from 76±13 to 106±19 G/L, P=0.006) although iron therapy could be discontinued only in 1 case. Transfusional requirements decreased from a median of 4 (range 2 to 13) Units of Red Cells in the 12 months before APC to 0 (0 to 4) during the 12 months after starting APC (P=0.001). The endoscopic severity of PHG (graded from 1 for mild, to 3 for severe) also improved (from 2.9±0.3 to 2±0.5, P=0.002). There were no serious complications due to APC (3 patients complained of transient pain). Only 1 patient died 18 months after APC due to liver failure. CONCLUSIONS: endoscopic therapy with APC is a safe and effective treatment for PHG which do not respond to the pharmacological therapy of portal hypertension. In these patients APC should be considered before more aggressive approaches