Endoscopic treatment of antral vascular ectasia – nationwide multicenter survey. APC or ligation?

Abstract

Introduction: Antral vascular ectasia is type of gastic vascular malformations, which can lead even to chronic iron-definciency anaemia or severe acute blood loss. About 30% of it can be observed in patients with liver cirrhosis, but there are a lot of other associated diseases (mainly autoimmune diseases) as well. The classic „watermelon“ type forms red streaking of the antrum with convergence at the pylorus with visible small, tortous vessels, but the diffuse form is similar to the antral gastritis. The severity of the disease is not associated with portal hypertension even in patients with cirrhosis. Effective medical treatment does not exist, therefore various endoscopic treatment modalities can be used. Aim: We sent a questionnary to major hungarian endoscopic centers to get information about endoscopic treatment of this rare entity. Patients & methods: We got data of 37 evaluable patients from 7 centers. 56% of them were women, the mean age was 67.2 (32–85) years. Liver cirrhosis was the underlying disease in 21 (56.8%) patients. Watermelon type was observed in 60% of all cases, while the occurence of diffuse form varied markedly between centers (0–70%). 30 patients were treated exclusively by argon plasma coagulation (APC), 6 patients were treated by ligation therapy (1 after unsuccessful APC therapies) and one patient had to be operated on in acute settings. Patients in APC group were treated at median 3 (1–20) sessions, the median number of ligation therapy was 1.5 (1–4). Results: In APC group two patients died, both due to hepatic coma, in 1 patient acute TIPS insertion had to be performed due to uncontrollable bleeding, but in the majority of remaining patients the intensity of blood loss, the need for further blood transfusion and hospitalisation decreased in followed ones. In 6 patients treated by ligation therapy 5 cases were evidently successfull with no further blood transfusion and hospitalisation in the follow up period of 3–24 months. Conclusion: The endoscopic treatment of antral vascular ectasia can be successfull for long term in majority of cases using APC or ligation therapy. Ligation therapy seems to be superior and more cost effective, but it needs further confirmation in larger group of patients.