Efficacy of argon plasma coagulation in the management of portal hypertensive gastropathy

Abstract

Objectives: Evaluation of the outcome and experience in 2 years of management of portal hypertensive gastropathy (PHG) by argon plasma coagulation (APC) in a cohort of Egyptian cirrhotic patients. Methods: This study was conducted over a 2-year period from January 2011 to February 2013. Upper gastrointestinal endoscopy was performed to evaluate the degree and site of PHG. APC was applied to areas with mucosal vascular lesions. Results: In total, 200 cirrhotic patients were enrolled; 12 patients were excluded due to death (n = 6) caused by hepatic encephalopathy (n = 3), hepatorenal syndrome (n = 2), or chronic lymphatic leukemia (n = 1), or did not complete the treatment sessions (n = 6), so 188 patients completed the study. PHG was mainly fundic in 73 patients (38.8 %), corporeal in 66 patients (35.1 %), and pangastric in 49 patients (26.1 %) (P = 0.026). Patients were exposed to APC and received proton pump inhibitors together with propranolol at a dose sufficient to reduce the heart rate by 25 % or down to 55 beats/min. The mean (± standard deviation) number of sessions was 1.65 ± 0.8; six patients needed four sessions (3.2 %), 19 patients needed three sessions (10.1 %), 74 patients needed two sessions (39.4 %), and 89 patients needed one session (47.3 %). Patients with fundic and corporeal PHG required the lowest number of sessions (P = 0.000). Patients were followed up every 2 months for up to 1 year; the end point was a complete response with improved anemia and blood transfusion requirement which was achieved after one session in 89 patients (75.4 %), two sessions in 24 patients (20.3 %) and three sessions in five patients (4.3 %). A complete response was more prevalent in patients with corporeal and fundic PHG (P = 0.04). Conclusions: After 2 years’ experience in managing PHG, we found that a combination of APC and non-selective beta blockers was highly efficacious and safe in controlling bleeding from PHG. In addition, APC alone is rapid, and effective in the control of PHG induced bleeding, especially when beta blockers are contraindicated.

Devices for endoscopic hemostasis of nonvariceal GI bleeding (with videos)

“…There were no significant differences in adverse event rates between the 2 groups 65 . APC has shown effectiveness for treatment of other types of UGIB including angioectasias, Dieulafoy lesions, portal hypertensive gastropathy, and tumor bleeding in small case series 66, 67, 68, 69. In a Korean retrospective series of 66 patients with obscure GI bleeding who underwent balloon enteroscopy and were found to have small-bowel angioectasias, 45 patients underwent endoscopic treatment (APC in 87%), and 21 did not receive any endoscopic treatment 70 .…”

Managing Acute Portal Hypertensive Gastropathy Bleed During the Time of COVID-19 Pandemic: Novelty or Necessity?

“…In uncontrolled active PHG-related bleeding, endoscopic cauterization and injection sclerotherapy have been advocated by some authors, even though the former has been studied only in chronically bleeding PHG and latter fallen out of practice in advanced liver disease with the advent of TIPS and liver transplant surgery. In extreme cases, TIPS placement, shunt surgery, and liver transplantation have been recommended [3]. There are no studies or reports on the use of band ligation for controlling acute PHG-related bleeding.…”

Endoscopy in Management of Portal Hypertension

“…APC has been evaluated for the treatment of PHG, in combination with adequate NSBB. This does reduce rates of blood transfusion, ICU admission, and improve hemoglobin levels in 80-90% of patients [51,52]. Hemospray is also an option for the treatment of active PHG bleeding.…”