Endoscopic cryotherapy for the management of gastric antral vascular ectasia
Endoscopic cryotherapy for the management of gastric antral vascular ectasia
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DOI：
10.1016/j.gie.2008.03.1109
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发表时间：
2008-11-01
影响因子：
7.7
通讯作者：
Marcon, Norman
中科院分区：
文献类型：
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作者：
Cho, Sarah;Zanati, Simon;Marcon, Norman
背景资料：胃窦血管扩张症（GAVE）是一种不常见的，但临床上显着的原因慢性GI bleeding.Objective：评估的有效性和安全性冷冻治疗内镜治疗GAVE.Design：患者接受了3届内镜冷冻治疗3周至6周的时间间隔，并有一个后续的内窥镜检查4周后。前瞻性地随访他们的临床和内镜反应。设置：三级保健中心，2004年10月至2006年4月。患者：患者年龄43至89岁，诊断为GAVE和记录缺铁性贫血。8例患者有明显的胃肠道出血史。8名患者（67%）此前曾接受过氩等离子凝固术（APC）治疗（中位数6次，范围1-10次），但无反应或复发。结果：入组了12名患者。6例患者（50%）完全缓解，6例患者部分缓解。在冷冻治疗前3个月和随访3个月期间，平均输血单位数分别为4.6和1.7单位。观察到平均Hb水平从9.9 g/dL增加至11.3 g/dL。冷冻治疗的平均持续时间为5分钟（范围1-15分钟）。在进行的36次冷冻治疗中，有32次（89%）在技术上可以治疗90%以上的GAVE病变。没有立即冷冻治疗相关的并发症，没有病人需要入院后procedure.Limitations：试点研究从一个单一center.Conclusions：内镜冷冻治疗是一种安全有效的治疗GAVE。它似乎是有效的，即使是对APC治疗难治的GAVE。最佳的冷冻剂、输送装置和治疗方案尚未确定。（Gastrointest Endosc 2008;68：895-902.）
Background: Gastric antral vascular ectasia (GAVE) is an uncommon but clinically significant cause of chronic GI bleeding.Objective: To assess the efficacy and safety of cryotherapy for endoscopic treatment of GAVE.Design: Patients received 3 sessions of endoscopic cryotherapy at 3-week to 6-week intervals and had a follow-up endoscopy 4 weeks thereafter. They were followed prospectively in terms of clinical and endoscopic response.Setting: Tertiary-care center, between October 2004 and April 2006.Patients: The patients were 43 to 89 years of age, with a diagnosis of GAVE and documented iron deficiency anemia. Eight patients had a history of overt GI bleeding. Eight patients (67%) had previously been treated with argon plasma coagulation (APC) (median 6 sessions, range 1-10 sessions) and failed to respond or had a recurrence.Results: Twelve patients were enrolled. Six patients (50%) had a complete response, and 6 patients had a partial response. The mean number of units of blood transfused in the period of 3 months before cryotherapy and during the period of follow-up of 3 months was 4.6 and 1.7 units, respectively. An increased mean Hb level, from 9.9 to 11.3 g/dL, was noted. The average duration of the cryotherapy was 5 minutes (range 1-15 minutes). In 32 of 36 cryotherapy treatment sessions performed (89%), it was technically possible to treat more than 90% of GAVE lesions. There were no immediate cryotherapy-related complications, and none of the patients required admission after the procedure.Limitations: A pilot study from a single center.Conclusions: Endoscopic cryotherapy is a safe and effective treatment for GAVE. It appears to be effective, even for GAVE refractory to APC therapy. Optimal cryogen, delivery device, and treatment protocols are yet to be determined. (Gastrointest Endosc 2008;68:895-902.)