Long-term Outcome of Argon Plasma Coagulation Therapy in 84 Patients with Bleeding Gastrointestinal Angiomata

Abstract

Background: Argon Plasma Coagulation (APC) is a widely used method of non-contact thermal hemostasis for bleeding vascular lesions of the GI tract. Although safety and short-term efficacy have been well established, there are no reports of long-term follow-up to determine whether the immediate benefits of such therapy are sustained. Methods: All patients who received APC for GI angiomata - gastric antral vascular ectasia (GAVE), hereditary hemorrhagic telangiectasia (HHT) and arteriovenous malformations (AVM) - at The Wellesley Hospital, Toronto, between June 1995 and Sept 1997, were identified. Available hospital records were reviewed, a patient telephone questionnaire was administered and family physicians contacted regarding further bleeding events, hospitalizations, endoscopy, iron supplements, transfusions and recent hemoglobins. Results: Follow-up data was obtained for 84 of 92 patients (90.2%) with a mean follow-up of 6.9 years. Mean age was 69.4 yrs. 44 (52.4%) patients were female. Patients treated included 41 with GAVE, 8 with HHT (1 colonic) and 35 with AVM (4 colonic). GAVE patients received an average of 3.13 initial treatment sessions, significantly more than those with HHT (1.38) or AVM (1.0) (p<0.0001). 49 (58.3%) patients died during the follow-up period (GAVE 63.4%, HHT 0%, AVM 65.7%, p=0.0016). Of the 35 living patients, 10 (28.6%) had no further bleeding. 25 patients (71.4%) with further bleeding - 8 overt and 17 occult - underwent 0.56 endoscopies/pt/yr and 0.40 APC treatments/pt/yr. No patients required surgery. Conclusions: Our data demonstrates a worse prognosis for patients with GAVE, with more initial treatment sessions, higher blood transfusion requirements and more APC treatments in follow-up than patients with AVM or HHT. Patients with AVM fared best, with minimal recurrence of bleeding and low transfusion and re-treatment requirements during follow-up. All-cause mortality for the entire group was unexpectedly high; ongoing evaluation of death certificates will help determine bleeding-associated mortality rates.