Brief Article
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World J Gastroenterol. May 14, 2013; 19(18): 2799-2805
Published online May 14, 2013. doi: 10.3748/wjg.v19.i18.2799
Long-term efficacy of endoscopic coagulation for different types of gastric vascular ectasia
Yukinori Imai, Yoshie Mizuno, Kiyoko Yoshino, Kazuhiro Watanabe, Kayoko Sugawara, Daisuke Motoya, Masashi Oka, Satoshi Mochida
Yukinori Imai, Yoshie Mizuno, Kiyoko Yoshino, Kazuhiro Watanabe, Kayoko Sugawara, Daisuke Motoya, Masashi Oka, Satoshi Mochida, Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Saitama 350-0495, Japan
Author contributions: Imai Y and Mochida S designed the study and wrote the paper; Imai Y, Mizuno Y and Motoya D performed endoscopic treatment; Yoshino K, Watanabe K and Sugawara K took care of patients; Oka M contributed to the discussion.
Correspondence to: Yukinori Imai, MD, PhD, Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama 350-0495, Japan. imai@saitama-med.ac.jp
Telephone: +81-49-2761198   Fax: +81-49-2761198
Received: November 24, 2012
Revised: February 1, 2013
Accepted: March 6, 2013
Published online: May 14, 2013
Abstract

AIM: To examine the long-term therapeutic efficacies of endoscopic cauterization for gastric vascular ectasia, according to the type of lesion.

METHODS: Thirty-eight patients with hemorrhagic gastric vascular ectasia (VE) were treated by endoscopic cauterization: 13 by heater probe coagulationand 25 by argon plasma coagulation. Depending on the number of lesions, 14 and 24 patients were classified into localized VE (≤ 10; LVE) and extensive VE (> 10; EVE), respectively. The patients were followed-up by repeated endoscopic examinations after the therapy, and the incidences of VE recurrence and re-bleeding from the lesions were evaluated.

RESULTS: Although the VE lesions disappeared initially in all the patients after the therapy, the recurrence of VE developed in 25 patients (66%) over a mid-term observation period of 32 mo, and re-bleeding occurred in 15 patients (39%). The recurrence of VE was found in all patients with EVE, with re-bleeding occurring in 14 patients (58%). In contrast, only 1 patient (7%) with LVE showed recurrence of the lesions and complicating hemorrhage. Both the cumulative recurrence-free rates and cumulative re-bleeding-free rates were significantly lower in the EVE group than in the LVE group (P < 0.001 and P < 0.001, respectively). Moreover, the cumulative re-bleeding-free rate in the EVE group was 47.6% at 1 year and 25.4% at 2 years in patients with chronic renal failure, which were significantly lower than the rates in the patients without chronic renal failure (83.3% and 74.1%, respectively) (P < 0.05).

CONCLUSION: The recurrence of VE and re-bleeding from the lesions was more frequent in the patients with EVE, especially in those with complicating renal failure.

Keywords: Gastric vascular ectasia, Heater probe coagulation, Argon plasma coagulation, Renal failure, Recurrence

Core tip: The aim of this study was to examine the long-term therapeutic efficacies of endoscopic cauterization for gastric vascular ectasia (VE), according to the type of lesion. Depending on the number of lesions, 14 and 24 patients were classified into localized vascular ectasia (≤ 10) and extensive VE (> 10; EVE), respectively. The incidences of VE recurrence and re-bleeding from the lesions were evaluated. The recurrence of VE and re-bleeding from the lesions was more frequent in the patients with EVE, especially in those with complicating renal failure, even after the initial successful arrest of bleeding and disappearance of the lesions by the endoscopic therapy.