Efficacy of argon plasma coagulation in the treatment of radiation-induced hemorrhagic gastroduodenal vascular ectasia

Abstract

Objective. Radiation-induced hemorrhagic gastroduodenal vascular ectasia (GDVE) is rare but difficult to manage. Argon plasma coagulation (APC) has not yet been evaluated in the treatment of radiation-induced hemorrhagic GDVE. The efficacy of APC in patients with radiation-induced hemorrhagic GDVE has been investigated in this article. Material and methods. Eighteen patients with upper gastrointestinal (GI) bleeding caused by radiation-induced GDVE, including 13 with hepatocellular carcinoma, 3 with pancreatic cancer, and 2 with cholangiocarcinoma, were treated with APC. The efficacy of APC was retrospectively evaluated, based on cessation of macroscopic GI bleeding, resolution or stabilization of anemia and transfusion dependence, endoscopic ablation of almost all vascular lesions, complications, and recurrence. Results. Mean patient age was 59 years (range 42–80 years). The median time from radiation to GDVE diagnosis was 4.6 months (range 3.3–21.5 months). The median number of APC sessions per patient was 2.4 (range 1–4). All 18 patients showed an endoscopic response to APC treatment, with sustained increases in mean hemoglobin level, from 6.6 g/dL (range 2.9–9.5g/dL) to 9.7 g/dL (range 7.1–12.7 g/dL) (p < 0.001), and decreased dependence on transfusion, from 9.1 (range 0–30) to 4.1 (range 0–15) units of packed red blood cells per patient (p = 0.038) after last endoscopic eradication by APC treatment. There were no major procedure-related adverse events or deaths. At a median follow up of 4.7 months (range 0.6–24.5 months), none of the patients experienced recurrence of GDVE. Conclusions. APC showed short-term effectiveness and safety in the treatment of radiation-induced hemorrhagic GDVE.