Endoscopic Argon Plasma Coagulation for the Treatment of Portal Hypertensive Gastropathy

Abstract

Purpose: Argon plasma coagulation (APC) has been used to treat chronic blood loss from gastric antral vascular ectasia. Its role in the management of chronic blood loss and anemia in patients with portal hypertensive gastropathy (PHG) is not settled. The purpose of this study was to evaluate the use of APC for the treatment of chronic blood loss and iron deficiency in patients with PHG. Methods: The study included 30 patients (17 post-menopausal females and 13 males, mean age 50.7 years) with liver cirrhosis, iron deficiency anemia and severe PHG diagnosed endoscopically. All had hemoglobin <10 gm/dl, with no active bleeding from varices within the previous 6 months. 18 patients had obliterated varices following endoscopic therapy, with the last session more than 6 months before inclusion, and 12 patients had varices that had not bled previously (7 grade 1 and 5 grade 2). Patients had APC sessions with multiple brief pulses delivered to all areas of visible angioectasias or red spots. Endoscopy was repeated after 3 weeks, and further sessions were performed as needed. Patients receiving blood transfusion or iron therapy within the preceding 3 months were not included in the study. Response was assessed by change in hemoglobin and serum iron parameters over the following 2 months after completion of the sessions. Results: APC was delivered in 1 session to 24 patients (16 fundal, 5 body, and 3 antral). Six patients had diffuse PHG with ectasia, 5 requiring 3 sessions and 1 patient requiring 4 sessions of APC. Hemoglobin, MCV, serum iron, and tranferrin saturation increased significantly over the following 2 months in all patients. Conclusions: APC is a safe procedure for the management of PHG. Short term result show favorable response in controlling chronic blood loss and iron deficiency. Whether these results are sustained over longer periods is to be evaluated.Table: Mean Hemoglobin & Iron Profile