Treatment with argon plasma coagulation for hemorrhagic gastric angiodysplasia in chronic renal failure patients undergoing maintenance dialysis

Abstract

Gastric angiodysplasia is currently recognized as an important cause of gastrointestinal bleeding and its morbidity is relatively higher in renal failure patients than in normal subjects. Gastric antral vascular ectasia (GAVE) is a relatively rare type of angiodysplasia characterized by submucosal capillary dilatation and fibromuscular hyperplasia. The first case of GAVE has been documented by Jabbari in 1984.
We encountered three cases of hemorrhagic gastric angiodysplasia including a case of GAVE and these cases were successfully treated with argon plasma coagulation (APC).
Case 1: A 60-year-old woman who had been treated with CAPD for 7 years was hospitalized for severe anemia and epigastralgia. In March 1999, gastrointestinal fiberscopy (GIF) showed typical watermelon stomach that corresponded to GAVE. Case 2: A 52-year-old male who received CAPD since 1995 for CRF was hospitalized on February 1999 due to tarry stool and severe anemia (Hgb 3.7g/dL, Hct 11.2%). Vascular ectasia and oozing were identified in the antrum by GIF. Pathological determination proved angiodysplasia in the biopsy specimen obtained from the antral area. Case 3: A 51-year-old male had been receiving hemodialysis for uremia since 1981. On March 1998, a transjugular intrahepatic portosystemic shunt was established for portal hypertension induced by liver cirrhosis. Then, the patient was admitted urgently due to severe anemia and tarry stool in July 1999. Diagnosis of diffuse antral vascular ectasia was based on recognition of diffuse vasodilatation and oozing in the antrum on GIF. APC was successfully carried out in these three patients without any complication. In cases 1 and 2, deterioration of renal anemia was not demonstrated during the six-months observation period. Additionally, in case 3, frequency of blood transfusion was significantly decreased. We consider APC a safe and effective therapy for gastric angiodysplasia with intestinal bleeding in patients undergoing maintenance dialysis.