Endoscopic cryotherapy for the treatment of bleeding mucosal vascular lesions of the GI tract: a pilot study.
BACKGROUND
Thermal therapy is the cornerstone of endoscopic treatment of bleeding mucosal lesions of the GI tract. However, there is a 20% failure rate and contact devices may be cumbersome in the treatment of large bleeding areas. A pilot study was conducted to evaluate the safety and efficacy of endoscopic cryotherapy for bleeding mucosal vascular lesions.


METHODS
Patients with recurrent bleeding from diffuse mucosal vascular lesions were treated with cryotherapy and had endoscopic and clinical follow-up.


RESULTS
Twenty-six patients with gastric and duodenal arteriovenous malformations (n = 7), watermelon stomach (n = 7), radiation-induced gastritis (n = 5), and radiation-induced proctitis (n = 7) were treated with mean of 3.4 (1.6) sessions. The best results were achieved in patients with radiation-induced proctitis, with cessation of bleeding in all 7 patients. Cryotherapy was also effective in patients with multiple arteriovenous malformations (86%) and watermelon stomach (71%). It was less effective in patients with radiation-induced damage to stomach and duodenum, although all patients in this group were debilitated because of disseminated malignancy.


CONCLUSIONS
Cryotherapy is a safe and effective treatment for bleeding from diffuse mucosal lesions of the GI tract. Bleeding from radiation-induced proctitis and multiple arteriovenous malformations is particularly responsive to endoscopic cryotherapy.
Kantsevoy
Sergey V
SV
Division of Gastroenterology, Johns Hopkins Hospital, Baltimore Maryland 21205, USA.
Cruz-Correa
Marcia R
MR
Vaughn
Cheryl A
CA
Jagannath
Sanjay B
SB
Pasricha
Pankaj J
PJ
Kalloo
Anthony N
AN
D000368:Aged; D001165:Arteriovenous Malformations / Q000150:complications / Q000628:therapy; D017679:Cryotherapy; D005260:Female; D020252:Gastric Antral Vascular Ectasia / Q000150:complications / Q000628:therapy; D005756:Gastritis / Q000150:complications / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011349:Proctitis / Q000150:complications / Q000628:therapy; D011832:Radiation Injuries / Q000150:complications / Q000628:therapy