Herediter hemorajik telenjektazili bir vakanın, argon plazma koagülasyonu ve destek tedavisi kombinasyonuyla başarılı yönetimi

Yıl 2013, Cilt: 21 Sayı: 1, - , 01.04.2013

Atakan Yeşil Ebubekir Şenateş Kadir Kayataş Banu Erkalma Şenateş Alper Güçlütürk Refik Demirtunç

https://doi.org/10.17940/endoskopi.74816

Öz

Herediter hemorajik telenjiektazi, otozomal dominant geçişli, birçok klinik bulguyla karakterize, anormal vasküler formasyonla ilişkili nadir gözlenen bir hastalıktır. Biz bu vakada, gastrointestinal sistemin multiple bölgesinde (özofagus, mide korpus ve antrumu, duodenum) anjiodisplazik lezyonlarla seyreden, öyküsünde dört kez geçirilmiş miyokard infarktüsü bulunan, acil servise melena ile başvuran 65 yaşındaki olguya tanı anında yapılan argon plazma koagülasyon ve supportif yaklaşım kombinasyonun tedavi başarısını gözlemledik. Tanı anında uygulanan argon plazma koagülasyon ve bipolar koagülasyon yöntemleri bir çok çalışmada tercih edilen yöntemler olmuştur. Bu nedenle biz bu olgumuzda argon plazma koagülasyon yöntemini ve çalış-malarda etkisi kanıtlanmış konservatif tedavi kombinasyonunu tercih ettik. Bizim vakamızın argon plazma koagülasyon yöntemiyle beraber destek tedavisine verdiği hızlı cevap argon plazma koagülasyonun herediter hemorajik telenjiektaziye bağlı anjiodisplazik lezyonlarda seçkin tedavi yöntemi olduğu görüşünü desteklemektedir.

Anahtar Kelimeler

Herediter hemorajik telenjiektazi, anjiodisplazik lezyon, argon plazma koagülasyon

The success of combination treatment in the management of a patient with hereditary hemorrhagic telangiectasia

Öz

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome), a vascular disorder with autosomal dominant transmission, has a variety of clinical manifestations. In this case, we monitored a 65-year-old female who admitted to our hospital with gastrointestinal bleeding. Her history revealed repeated myocardial infarction (4 times). We diagnosed multiple angiodysplastic lesions with endoscopic examination. We evaluated the success of combination treatment with argon plasma coagulation and supportive approach at the time of diagnosis. argon plasma coagulation and bipolar coagulation methods have been reported as the preferred treatments in several studies. Therefore, we preferred the combination of argon plasma coagulation and conservative treatment methods in our case. The rapid healing observed with this treatment supports that combination treatment is effective in angiodysplastic lesions associated with hereditary hemorrhagic telangiectasia

Anahtar Kelimeler

Hereditary hemorrhagic telangiectasia, angiodysplastic lesions, argon plasma coagulation

Kaynakça

• Govani FS, Shovlin CL. Hereditary haemorrhagic telangiectasia a clinical and scientific review. Eur J Hum Genet 2009;17:860-71.
• Shovlin CL. Hereditary haemorrhagic telangiectasia:pathophysiology, diag- nosis and treatment. Blood Rev 2010;24:203-19.
• Fiorella ML, Lillo L, Fiorella R. Diode laser in the treatment of epistaxis in patients with hereditary haemorrhagic telangiectasia. Acta Otorhinolaryngol Ital 2012;32:164-9.
• Candelli M, Pompili M, Suppressa P, et al. Liver involvement in hereditary hemorrhagic telangiectasia: can breath test unmask impaired hepatic first- pass effect? Intern Emerg Med 2012;7:323-9.
• Olitsky SE. Hereditary hemorrhagic telangiectasia: diagnosis and manage- ment. Am Fam Physician 2010;82:785-90.
• Hsi DH, Ryan GF, Hellems SO, et al. Large aneurysms of the ascending aorta and major coronary arteries in a patient with hereditary hemorrhagic telangiectasia. Mayo Clin Proc 2003;78:774-6.
• Zarrabeitia R, Albiñana V, Salcedo M, et al. A review on clinical manage- ment and pharmacological therapy on hereditary haemorrhagic telangiecta- sia (HHT). Curr Vasc Pharmacol 2010;8:473-81.
• Johnston CM, Schoenfeld LP, Mysore JV, Dubois A. Endoscopic spray cryo- therapy: a new technique for mucosal ablation in the esophagus. Gastroin- test Endosc 1999;50:86-92.
• Pavey DA, Craig PI. Endoscopic therapy for upper-GI vascular ectasias. Gas- trointest Endosc 2004;59:233-8.
• Kantsevoy SV, Cruz-Correa MR, Vaughn CA, et al. Endoscopic cryotherapy for the treatment of bleeding mucosal vascular lesions of the GI tract: a pilot study. Gastrointest Endosc 2003;57:403-6.
• Lewis BS, Salomon P, Rivera-MacMurray S, et al. Does hormonal ther- apy have any benefit for bleeding angiodysplasia? J Clin Gastroenterol 1992;15:99-103.
• Barkin JS, Ross BS. Medical therapy for chronic gastrointestinal bleeding of obscure origin. Am J Gastroenterol 1998;93:1250-4.
• Hodgson H. Hormonal therapy for gastrointestinal angiodysplasia. Lancet 2002;359:1630-1.
• Plessevaux H, Coremans G, Rutgeert P, et al. Octreotide in the treatment of bleeding gastrointestinal vascular malformations. Gastroenterology 1996;110:A353.
• Orsi P, Guatti-Zuliani C, Okolicsanyi L. Long-acting octreotide is effective in controlling rebleeding angiodysplasia of the gastrointestinal tract. Dig Liver Dis 2001;33:330-4.
• Nardone G, Rocco A, Balzano T, Budillon G. The efficacy of octreotide ther- apy in chronic bleeding due to vascular abnormalities of the gastrointestinal tract. Aliment Pharmacol Ther 1999;13:1429-36.
• Takasu S, Sakurai Y. Vascular ectasia (angiodysplasia). Nihon Naika Gakkai Zasshi 1994;83:1266-70.
• Jensen D, Jutabha R, Kovacs T, et al. A randomized prospective study of en- doscopic hemostasis with argon plasma coagulator compared to Gold Probe for bleeding GI angiomas. Gastrointest Endosc 1999;49:AB167.
• Ragsdale JA. Hereditary hemorrhagic telangiectasia: from epistaxis to life- threatening GI bleeding. Gastroenterol Nurs 2007;30:293-9.
• Gordon FH, Watkinson A, Hodgson H. Vascular malformations of the gas- trointestinal tract. Best Pract Res Clin Gastroenterol 2001;15:41-58.
• Foutch PG, Sawyer R, Sanowski RA. Push-enteroscopy for diagnosis of pa- tients with gastrointestinal bleeding of obscure origin. Gastrointest Endosc 1990;36:337-41.
• Kwan V, Bourke MJ, Williams SJ, et al. Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up. Am J Gastroenterol 2006;101:58-63.
• Olmos JA, Marcolongo M, Pogorelsky V, et al. Argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias. Gastrointest Endosc 2004;60:881-6.
• Olmos JA, Marcolongo M, Pogorelsky V, et al. Long-term outcome of argon plasma ablation therapy for bleeding in 100 consecutive patients with co- lonic angiodysplasia. Dis Colon Rectum 2006;49:1507-16.
• Kurnik PB, Heymann WR. Coronary artery ectasia associated with heredi- tary hemorrhagic telangiectasia. Arch Intern Med 1989;149:2357-9.
• Tsuiki K, Tamada Y, Yasui S. Coronary artery aneurysm without stenosis in association with Osler-Weber-Rendu disease-a case report. Angiology 1991;42:55-8.
• Bugiardini R, Bairey Merz CN. Angina with ‘normal’ coronary arteries: a changing philosophy. JAMA 2005;293:477-84.