Endoscopic treatment of gastric and duodenal angiodysplasias by elastic rings ligation

Introduction. The most frequently applied methods of endoscopic treatment of angiodysplasias, such as argon plasma coagulation, multipolar coagulation and heater probe, proved to be effective with certain shortcomings and the possibility of complications. There are very scarce data in the literature about the treatment of angiodysplasias with endoscopic ligature. Objective. The aim of the study was to examine the efficacy and safety of endoscopic treatment of gastric and duodenal angiodysplasias by ligation with elastic rings. Methods. In 12 patients (10 male and 2 female, mean age 65.9 years) the endoscopic ligation of gastric and duodenal angiodysplasias was applied. Eight patients (66.6%) had solitary angiodysplasias in the stomach, two patients (16.6%) had solitary angiodysplasias in the descending part of the duodenum and two patients (16.6%) had multiple angiodysplasias in the stomach and duodenum. Two patients (16.6%) had active bleeding from angiodysplasias, while 10 patients (83.3%) had recent bleeding. We used the Cook Endoscopy system with 4 or 6 elastic rings for endoscopic ligation of angiodysplasias. Patients were under follow-up after 2-3 days, 30 days and then every 6 months following the endoscopic ligation of angiodysplasias. Results. Active bleeding from angiodysplasias was stopped in two patients (100%) by endoscopic ligation with elastic rings. The average number of applied ligation sessions in our 12 patients was 1.6, with an average of 1.8 ligatures per session. There were no complications after ligation of angiodysplasias. Recurrence of bleeding occurred in one patient (8.3%) with multiple gastric and duodenal angiodysplasias. The average period of follow-up of patients was 22.8?17.6 months. Conclusion. Endoscopic ligation with elastic rings can be effective and safe for treatment especially of solitary gastric and duodenal angiodysplasias.

Download Full-text

Watermelon stomach: clinical aspects and treatment with argon plasma coagulation

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032006000300007 ◽

2006 ◽

Vol 43 (3) ◽

pp. 191-195 ◽

Cited By ~ 19

Author(s):

Dalton M. Chaves ◽

Paulo Sakai ◽

Cláudio V. Oliveira ◽

Spencer Cheng ◽

Shinichi Ishioka

Keyword(s):

Liver Disease ◽

Endoscopic Treatment ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Gastric Antral Vascular Ectasia ◽

Plasma Coagulation ◽

Vascular Ectasia ◽

Group 2 ◽

Group 1

BACKGROUND: Gastric antral vascular ectasia is a disorder whose pathogenetic mechanism is unknown. The endoscopic treatment with argon plasma coagulation has been considered one of the best endoscopic therapeutic options. AIM: To analyze the endoscopic and clinical features of gastric antral vascular ectasia and its response to the argon plasma coagulation treatment. PATIENTS AND METHODS: Eighteen patients were studied and classified into two groups: group 1 - whose endoscopic aspect was striped (watermelon) or of the diffuse confluent type; group 2 - diffuse spotty nonconfluent endoscopic aspect. RESULTS: Group 1 with eight patients, all having autoimmune antibodies, but one, whose antibodies were not searched for. Three were cirrhotic and three had hypothyroidism. All had gastric mucosa atrophy. In group 2, with 10 patients, all had non-immune liver disease, with platelet levels below 90.000. Ten patients were submitted to argon plasma coagulation treatment, with 2 to 36 months of follow-up. Lesions recurred in all patients who remained in the follow-up program and one did not respond to treatment for acute bleeding control. CONCLUSION: There seem to be two distinct groups of patients with gastric antral vascular ectasia: one related to immunologic disorders and other to non-immune chronic liver disease and low platelets. The endoscopic treatment using argon plasma coagulation had a high recurrence in the long-term evaluation.

Download Full-text

Argon plasma coagulation for Barrett’s esophagus with low-grade dysplasia: a randomized trial with long-term follow-up on the impact of power setting and proton pump inhibitor dose

Endoscopy ◽

10.1055/a-1203-5930 ◽

2020 ◽

Author(s):

Ewa Wronska ◽

Marcin Polkowski ◽

Janina Orlowska ◽

Andrzej Mroz ◽

Paulina Wieszczy ◽

...

Keyword(s):

Argon Plasma Coagulation ◽

Argon Plasma ◽

Low Grade ◽

Efficacy And Safety ◽

Plasma Coagulation ◽

Complete Ablation ◽

Power Setting ◽

The Impact

Background This study evaluated the impact of power setting and proton pump inhibitor (PPI) dose on efficacy and safety of argon plasma coagulation (APC) of Barrett’s esophagus (BE) with low-grade dysplasia (LGD). Methods 71 patients were randomized to APC with power set at 90 W or 60 W followed by 120 mg or 40 mg omeprazole. The primary outcome was the rate of complete (endoscopic and histologic) ablation of BE at 6 weeks. Secondary outcomes included safety and long-term efficacy. Results Complete ablation rate in the 90 W/120 mg, 90 W/40 mg, and 60 W/120 mg groups was 78 % (18/23; 95 % confidence interval [CI] 61–95), 60 % (15/25; 95 %CI 41–79), 74 % (17/23; 95 %CI 56–92), respectively, at 6 weeks and 70 % (16/23; 95 %CI 51–88), 52 % (13/25; 95 %CI 32–72), and 65 % (15/23; 95 %CI 46–85) at 2 years post-treatment (differences not significant). Additional APC was required in 28 patients (23 residual and 5 recurrent BE). At median follow-up of 108 months, 66/71 patients (93 %; 95 %CI 87–99) maintained complete ablation. No high-grade dysplasia or adenocarcinoma developed. Overall, adverse events (97 % mild) did not differ significantly between groups. Chest pain/discomfort was more frequent in patients receiving 90 W vs. 60 W power (P < 0.001). One patient had esophageal perforation and two developed stenosis. Conclusions APC power setting and PPI dose did not impact efficacy and safety of BE ablation. Complete ablation of BE with LGD was durable in > 90 % of patients, without any evidence of neoplasia progression in the long term.

Download Full-text