An elderly case of acute myelocytic leukemia complicated with bleeding gastric angiodysplasia, successfully treated with topical endoscopic polidocanol injection

A 72-year-old man with acute myelocytic leukemia (AML) suffered relapsing massive bleeding from gastric angiodysplasia. He was referred to our hospital in February 2000 because of anemia and thrombocytopenia. He had hypercellular (nudeated cell count 42×104/μl) bone marrow with 90% myeloblasts, and AML (FAB:M1) was diagnosed. Remission induction therapy by BHAC/DM regimen failed. While considering subsequent regimens, massive hematemesis from a solitary gastric angiodysplasia developed. In April, after re-remission induction by CAG regimen, hematemesis from the same lesion reccurred. Hemostasis was achieved by topical transendoscopic injection of polidocanol. After achievement of complete remission by CAG therapy, he was treated on an outpatient basis. In July, his AML relapsed and he was treated mainly by transfusion therapy. In September, hematemesis recurred resulting in hemostasis with the same procedure. In the course of endoscopic injections, his mucosal lesion became difficult to observe. Gastric angiodysplasia is occasionally observed in the elderly, but massive bleeding is a rare complication. In this case, topical injection of polidocanol was an effective procedure for the massive bleeding from it even in an elderly patient with the complication of thrombocytopenia due to AML.