title: Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding.
abstract: OBJECTIVE
  Vascular malformations are the most common sources of bleeding in the small bowel. They can be treated with argon plasma coagulation (APC) during double-balloon enteroscopy (DBE). This study aimed to evaluate the long-term follow-up of the effectiveness of APC for small-bowel bleeding by means of a single-center retrospective study.
  
  
  METHODS
  Between June 2003 and December 2005, APC treatment for small-bowel lesions was carried out during DBE in 63 patients with known or suspected mid-gastrointestinal bleeding. Fifty patients were included in the analysis. Main outcome measurements were comparison of hemoglobin values and blood transfusion requirements before and after APC, and rebleeding rates.
  
  
  RESULTS
  Twenty-nine patients (58%) had only oral DBE, whereas 21 patients (42%) underwent combined oral and anal approaches. The most frequent bleeding sources treated with APC were angiodysplasias in 44 patients (88%). Hemoglobin levels increased distinctly and stabilized after APC during a mean long-term follow-up of 55 ± 7 months, with mean levels of 7.6 g/dL before APC and 11.0 g/dL afterwards. Blood transfusion requirements substantially declined, from 30 patients (60%) before APC to 8 (16%) afterwards. However, small-bowel bleeding recurred in 21 patients (42%), particularly in patients with Osler disease (6 of 8 patients, 75%).
  
  
  CONCLUSIONS
  Bleeding sources in the small bowel can be effectively treated with APC using DBE, and long-term follow-up data show a clear increase in hemoglobin levels and reduced blood transfusion requirements after APC. Further efforts are needed to reduce the rebleeding rate, possibly through more intensive initial treatment.
authors.affiliation: Department of Internal Medicine II, HSK Wiesbaden, Teaching Hospital of the University of Mainz, Ludwig-Erhard-Strasse 100, Wiesbaden, Germany. andrea.may@hsk-wiesbaden.de
authors.forename: A
authors.initials: A
authors.lastname: May
authors.forename: T
authors.initials: T
authors.lastname: Friesing-Sosnik
authors.forename: H
authors.initials: H
authors.lastname: Manner
authors.forename: J
authors.initials: J
authors.lastname: Pohl
authors.forename: C
authors.initials: C
authors.lastname: Ell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016888:Angiodysplasia / Q000150:complications / Q000601:surgery; D057908:Argon Plasma Coagulation; D058582:Double-Balloon Enteroscopy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D054079:Vascular Malformations / Q000150:complications / Q000601:surgery
chemical_list: D006454:Hemoglobins