Argon plasma coagulation for treatment of watermelon stomach.
OBJECTIVE
Watermelon stomach or gastric antral vascular ectasia (GAVE) is a rare but well-recognized cause of gastrointestinal blood loss, which typically affects elderly women. Historically patients were treated with antrectomy but this has been largely replaced by endoscopic therapy such as Nd:YAG laser. Argon plasma coagulation (APC) is a new noncontact electocoagulation technique which has several theoretical advantages over laser. The objective of this study was to assess the efficacy of APC in treating GAVE.


METHODS
We retrospectively reviewed the case-records of five patients (four women, one man) with iron deficiency anaemia or gastrointestinal blood loss due to GAVE who were treated with APC and for whom a follow-up of more than 12 months was available. Four patients were transfusion-dependent. Their mean age was 71 years (range 58 - 83). The mode of presentation, number of treatment sessions, response to therapy and recurrence (if any) were recorded.


RESULTS
A mean of 2.6 treatment sessions per patient were required. All patients had an endoscopically observed response to therapy and all patients had a sustained rise in hemoglobin level after treatment. Transfusion dependence ceased in all patients. After a mean follow-up of 20 months GAVE recurred in two patients (40 %). Both patients responded to further APC treatment. No major complications were recorded.


CONCLUSIONS
APC is a safe and effective short-term treatment for GAVE. The natural history of the condition is uncertain, and at medium-term follow-up GAVE is found to recur in a substantial number of patients treated with APC. Re-treatment with APC is an option in these patients.
Yusoff
I
I
Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia.
Brennan
F
F
Ormonde
D
D
Laurence
B
B
D000368:Aged; D000369:Aged, 80 and over; D001128:Argon / Q000009:adverse effects* / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000502:physiology*; D004564:Electrocoagulation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D020252:Gastric Antral Vascular Ectasia / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
D001128:Argon