title: Efficacy of argon plasma coagulation in the treatment of radiation-induced hemorrhagic gastroduodenal vascular ectasia.
abstract: OBJECTIVE
  Radiation-induced hemorrhagic gastroduodenal vascular ectasia (GDVE) is rare but difficult to manage. Argon plasma coagulation (APC) has not yet been evaluated in the treatment of radiation-induced hemorrhagic GDVE. The efficacy of APC in patients with radiation-induced hemorrhagic GDVE has been investigated in this article.
  
  
  METHODS
  Eighteen patients with upper gastrointestinal (GI) bleeding caused by radiation-induced GDVE, including 13 with hepatocellular carcinoma, 3 with pancreatic cancer, and 2 with cholangiocarcinoma, were treated with APC. The efficacy of APC was retrospectively evaluated, based on cessation of macroscopic GI bleeding, resolution or stabilization of anemia and transfusion dependence, endoscopic ablation of almost all vascular lesions, complications, and recurrence.
  
  
  RESULTS
  Mean patient age was 59 years (range 42-80 years). The median time from radiation to GDVE diagnosis was 4.6 months (range 3.3-21.5 months). The median number of APC sessions per patient was 2.4 (range 1-4). All 18 patients showed an endoscopic response to APC treatment, with sustained increases in mean hemoglobin level, from 6.6 g/dL (range 2.9-9.5 g/dL) to 9.7 g/dL (range 7.1-12.7 g/dL) (p < 0.001), and decreased dependence on transfusion, from 9.1 (range 0-30) to 4.1 (range 0-15) units of packed red blood cells per patient (p = 0.038) after last endoscopic eradication by APC treatment. There were no major procedure-related adverse events or deaths. At a median follow up of 4.7 months (range 0.6-24.5 months), none of the patients experienced recurrence of GDVE.
  
  
  CONCLUSIONS
  APC showed short-term effectiveness and safety in the treatment of radiation-induced hemorrhagic GDVE.
authors.affiliation: Center for Liver Cancer, National Cancer Center , Goyang , Korea.
authors.forename: Hee-Won
authors.initials: HW
authors.lastname: Kwak
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.forename: Sang Myung
authors.initials: SM
authors.lastname: Woo
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Kim
authors.forename: Joong-Won
authors.initials: JW
authors.lastname: Park
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Kim
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Sung-Sik
authors.initials: SS
authors.lastname: Han
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Sang-Jae
authors.initials: SJ
authors.lastname: Park
authors.forename: Myeong Cherl
authors.initials: MC
authors.lastname: Kook
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation / Q000009:adverse effects; D001803:Blood Transfusion; D004067:Digestive System Neoplasms / Q000532:radiotherapy*; D005260:Female; D020252:Gastric Antral Vascular Ectasia / Q000209:etiology / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011708:Pylorus / Q000528:radiation effects*; D011832:Radiation Injuries / Q000150:complications*; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D012189:Retrospective Studies