1. GASTROINTESTINAL ENDOSCOPY 2008; 67(2) : 219-225
Bleeding gastric vascular ectasia treated by argon plasma coagulation: a comparison between patients with and without cirrhosis
Ste´phane Lecleire, MD, Emmanuel Ben-Soussan, MD, Michel Antonietti, MD, Odile Goria, MD,Ghassan Riachi, MD, Eric Lerebours, MD, PhD, Philippe Ducrotte´, MD, PhD
GASTROINTESTINAL ENDOSCOPY 2008; 67(2) :
R1 김민경

2. Introduction Gastric vascular ectasia (GVE)
represents an uncommon cause of GI hemorrhage
mostly chronic, revealed by a recurrent IDA, or less frequently by acute overt digestive bleeding
can affect not only patients with cirrhosis but also patients with a variety of chronic diseases.
Over gi bleeding: intermittent melena or hematemesis

3. Introduction Endoscopic finding Histologic finding
Flat or raised erythematous stripes radiating in a spoke like fashion from the pylorus to the antrum
Coalescence of many angiodysplastic lesions in antrum
Histologic finding
Gastirc mucosa: supf.fibromuscular hyperplasia with capillary ectasia and microvascular thrombosis in the lamina propria
Most frequent condition ass with gave is LC 75%of Gave. 그외에도 CRF, chronic valvular, ischemic, or hypertensive heart diseases, and avariety of autoimmune disease

4. GVE The aim of this study
To determine whether clinical presentation, endoscopic appearance and endoscopic success of APC was different in patient with and without cirrhosis

5. Method Patents and methode Diagnosis Patients
Retrospective , January 2001 ~ December 2005
GVE treated by APC for overt GI bleeding or IDA.
Diagnosis
By 4 skilled gastroenterologist
Watermelon stomach, Honeycomb stomach
Bleeding, Portal hypertensive congestive gastropathy(PHG), Biosy

6. Method Endoscopic procedure : General anesthesia Follow up
APC - Electrocoagulation of all angiectasias,
Argon gas flow o.8-1L/min, electric power output 50 to 70 W,
Combination of focal pulse and spray painting technique
Treatment setting duration:15 to 45 minutes
Follow up
Clinical examination ,blood test, Hb at least months after first treatment session
Another APC
Anemia recurrence or overt GI bleeding recurrence
Definitive criteria for successful Tx
Cessation of the patient’s initial Sx & cessation of transfusion of RBC

7. Results

8. Baseline clinical characteristics

9. Endoscopy

11. Results Follow up Group1 (Cirrhotic) 20moth Group2 (Noncirrhotic)
24month
Cause of death
Intractable overt bleeding: 2
SBP: 3
Hepatorenal syndrome: 2
Hepatic failure:1
Acute pneumonia:1
Intractable overt bleeding: 1
Regular PRBC transfusioin: 2
Non GI cancer: 2
Terminal cardiac failure: 2

12. Discussion

13. First purpose of study APC effectiveness on bleeding GVE
APC successful treatment for the treatment of bleeding GVE
Medical therapy
Recurrence of chronic bleeding
Surgery
antrectomy: definitely effective
7.4% mortality rate

14. -diffuse antral localization
Second purpose of out study
Compare the clinical and endoscopic characteristics of G1 and G2
Group 1
Group 2
Honey comb
-round and spaced
Watermelon
-diffuse antral localization
2.18
3.77

15. Why APC is an effective hemostatic treatment for GVE, whatever the etiology

16. Conclusions
APC treatment of bleeding GVE was efficient and safe in cirrhotic and noncirrhotic patients.
Noncirrhotic patients required significantly more APC sessions to achieve a complete treatment.
The use of antiplatelet drugs and an endoscopic watermelon appearance were both associated with and increased risk of APC treatment failure