Tolerance and efficacy of argon plasma coagulation for controlling bleeding in patients with typical and atypical manifestations of watermelon stomach.

Abstract

Watermelon stomach is a well-known cause of gastrointestinal bleeding and anemia. This study investigated the efficacy of and patient tolerance for argon plasma coagulation (APC) in this condition. The reports of 21 patients with watermelon stomach who were treated using APC from February 1998 to August 2001 were reviewed. The efficacy of APC was evaluated on the basis of the patients' symptoms, transfusion requirements, and hemoglobin levels. Fifty-nine APC sessions were carried out (mean 2.81 sessions per patient, range one to five). Depending on the bleeding outcome and lesion intensity, repeat treatments were carried out with a mean delay of 1.8 months (range 2 days - 6 months). The mean follow-up period after the last session was 14.9 months (1 - 60.6 months). All of the patients required repeated blood transfusions before APC, compared with only two patients after treatment. One of these two patients died of uncontrolled bleeding despite APC. The mean hemoglobin level was 80.9 g/l before treatment, compared with 103.2 g/l after treatment. Three patients had recurrent bleeding 4.4 - 31.7 months (mean 13.8 months) after the last session and required a further session of APC, which controlled bleeding in all cases. Complications encountered consisted of two cases of hematemesis and one of sepsis. APC was effective in controlling bleeding due to watermelon stomach in the great majority of patients, with a low complication rate.