Abstract
BackgroundVascular ectasias, including gastric antral vascular ectasia (GAVE) and angiodysplasia, are increasingly recognized as important sources of gastrointestinal bleeding. This study investigated and compared the efficacies and outcomes of treatment of upper gastrointestinal (UGI) angiodysplasia and GAVE hemorrhage by endoscopic argon plasma coagulation (APC).MethodsFrom January 2006 to December 2009, 46 patients diagnosed with upper GI bleeding caused by angiodysplasia or GAVE at a tertiary hospital were recruited into this study. They included 26 males and 20 females with an average age of 65.6 years (range, 45–90 years). All patients underwent APC for hemostasis during an endoscopic procedure. Parameters such as underlying co-morbidities, number of endoscopic treatment sessions, recurrent bleeding, and clinical outcomes during follow-up were analyzed.ResultsThe 46 patients with UGI vascular ectasia hemorrhage included 27 patients with angiodysplasia and 19 with GAVE. The patients with angiodysplasia were older than those with GAVE (71.6 ± 10.2 years versus 61.8 ± 11.9 years, P = 0.005). More GAVE patients than angiodysplasia patients had co-existing liver cirrhosis (63.2% versus 25.9%, P = 0.012). The patients with GAVE had a higher rate of recurrent bleeding (78.9% versus 7.4%, P < 0.001) and required more treatment sessions to achieve complete hemostasis (2.4 ± 1.4 versus 1.1 ± 0.1, P < 0.001) than those with angiodysplasia. Univariate analysis demonstrated that age greater than 60 years (odds ratio (OR) = 8.929, P = 0.003), GAVE (OR = 0.021, P < 0.001), and previous radiation therapy (OR = 11.667, P = 0.032) were associated with higher rates of recurrent bleeding. Further multivariate analysis revealed that GAVE was the only independent risk factor for recurrent bleeding after APC treatment (OR = 0.027, P < 0.001).ConclusionEndoscopic hemostasis with APC is a safe treatment modality for both angiodysplasia and vascular ectasia bleeding. The efficacy of APC treatment is greater for angiodysplasia than for vascular ectasia bleeding. GAVE patients have a higher recurrent bleeding rate and may require multiple treatment sessions for sustained hemostasis.
Highlights
Vascular ectasias, including gastric antral vascular ectasia (GAVE) and angiodysplasia, are increasingly recognized as important sources of gastrointestinal bleeding
The clinical presentation ranges from chronic gastrointestinal blood loss that leads to chronic anemia to serious gastrointestinal events such as melena or hematemesis, which occur especially in patients with underlying conditions leading to bleeding tendencies, such as liver cirrhosis, or uremia
From January 2006 to December 2009, we retrospectively reviewed the medical records of 46 consecutive patients diagnosed with upper GI bleeding caused by angiodysplasia or GAVE at a university-affiliated tertiary care center
Summary
Vascular ectasias, including gastric antral vascular ectasia (GAVE) and angiodysplasia, are increasingly recognized as important sources of gastrointestinal bleeding. Gastrointestinal vascular ectasia comprises angiodysplasia, gastric antral vascular ectasia (GAVE), and other forms of telangiectasia related to multisystemic disease, such as hereditary hemorrhagic telangiectasia, but not vascular tumors and Dieulafoy’s lesion [1,2]. GAVE and angiodysplasia are the most common forms of upper gastrointestinal (UGI) vascular ectasia. Both are increasingly recognized as important sources of GI bleeding, accounting for up to 4% and 3% of cases of upper and lower GI bleeding, respectively [1,2,3,4]. The clinical presentation ranges from chronic gastrointestinal blood loss that leads to chronic anemia to serious gastrointestinal events such as melena or hematemesis, which occur especially in patients with underlying conditions leading to bleeding tendencies, such as liver cirrhosis, or uremia
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