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Endoscopy 2011; 43(9): 759-765
DOI: 10.1055/s-0030-1256388
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding

A.  May1 , T.  Friesing-Sosnik1 , H.  Manner1 , J.  Pohl1 , C.  Ell1
  • 1Department of Internal Medicine II, HSK Wiesbaden (Teaching Hospital of the University of Mainz), Wiesbaden, Germany
Further Information

Publication History

submitted 23 April 2010

accepted after revision 31 January 2011

Publication Date:
03 May 2011 (online)

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Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleedingEndoscopy 2012; 44(03): 304-304
DOI: 10.1055/s-0032-1306669

Background and study aims: Vascular malformations are the most common sources of bleeding in the small bowel. They can be treated with argon plasma coagulation (APC) during double-balloon enteroscopy (DBE). This study aimed to evaluate the long-term follow-up of the effectiveness of APC for small-bowel bleeding by means of a single-center retrospective study.

Patients and methods: Between June 2003 and December 2005, APC treatment for small-bowel lesions was carried out during DBE in 63 patients with known or suspected mid-gastrointestinal bleeding. Fifty patients were included in the analysis. Main outcome measurements were comparison of hemoglobin values and blood transfusion requirements before and after APC, and rebleeding rates.

Results: Twenty-nine patients (58 %) had only oral DBE, whereas 21 patients (42 %) underwent combined oral and anal approaches. The most frequent bleeding sources treated with APC were angiodysplasias in 44 patients (88 %). Hemoglobin levels increased distinctly and stabilized after APC during a mean long-term follow-up of 55 ± 7 months, with mean levels of 7.6 g/dL before APC and 11.0 g/dL afterwards. Blood transfusion requirements substantially declined, from 30 patients (60 %) before APC to 8 (16 %) afterwards. However, small-bowel bleeding recurred in 21 patients (42 %), particularly in patients with Osler disease (6 of 8 patients, 75 %).

Conclusions: Bleeding sources in the small bowel can be effectively treated with APC using DBE, and long-term follow-up data show a clear increase in hemoglobin levels and reduced blood transfusion requirements after APC. Further efforts are needed to reduce the rebleeding rate, possibly through more intensive initial treatment.

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A. MayMD, PhD 

Department of Internal Medicine II
HSK Wiesbaden

Ludwig-Erhard-Str. 100
65199 Wiesbaden
Germany

Fax: +49-611-432418

Email: andrea.may@hsk-wiesbaden.de