Gastric Antral Vascular Ectasia: Does APC Cautery Really Decrease Bleeding?

Abstract

Watermelon stomach (gastric antral vascular ectasia), is an uncommon condition affecting the antrum which often presents with anemia presumed to be secondary to bleeding. Treatment has ranged from supportive (iron supplementation, transfusions) to surgical intervention to medical therapy (i.e. estrogens) to endoscopic treatment. Endoscopic therapy includes cautery, which can be either contact (bipolar) or non contact (argon plasma coagulation-APC). Several studies with APC have concluded that it is a safe and effective way of treating GAVE. We have noticed that despite adequate non-contact cautery, a number of our patients with GAVE continue to have transfusion requirements. Objective: To determine the benefit of multiple APC treatments on transfusion requirements in patients with transfusion requirements documented through a provincial blood bank database. Methods/Results: We have prospectively collected data on 35 consecutive GAVE patients in an effort to determine clinical outcomes. Of these, 22 patients (15 female) treated between 2002-2004 had complete provincial blood bank data for one year prior and one year post-therapy available. Over the treatment period (0 to 2.2 years, mean 7 months), the mean blood transfusion requirement was 7.8 units of PRBC (range 0 to 55 units) with a mean number of APC treatments at 3.5 (range 1 to 8). We compared the transfusions requirements (0 to 59 units, mean 11.09) 1 year prior to the first APC treatment to the transfusion requirements (0 to 50 units, mean 5.73) in the year following the last APC treatment and found that APC treatments did not statistically reduce the transfusion requirements of our patients (mean of the difference 5.4, SD 18.1, p-value > 0.17 with or without adjusting other clinical factors like age, and gender. Even when excluding two patients who ‘skewed’ the data, the differences in transfusion requirements was still not significant. Conclusion: Although in selected patients cautery of GAVE appears to have impressive endoscopic results, in patients with transfusion requirements and GAVE, our data suggests that APC has not significantly decreased transfusion requirements, despite apparent endoscopic success. Factors responsible for this treatment inefficiency are being explored however, it appears that at least some of the patients have other sources (i.e. small intestinal) of bleeding.