Radiofrequency ablation for treatment of refractory gastric antral vascular ectasia (with video)

Abstract

Background and study aims: Gastric antral vascular ectasia (GAVE) is a known cause of gastrointestinal bleeding and chronic iron deficiency anemia. Endoscopic therapy with argon plasma coagulation (APC) is widely used for treatment of GAVE, but most patients continue to require repeated blood transfusions and multiple endoscopic procedures (refractory GAVE). We describe our initial experience regarding safety and efficacy of radiofrequency ablation (RFA) therapy in treating patients with refractory GAVE. Patients and methods: We prospectively enrolled seven patients with refractory GAVE who had multiple prior treatments with APC. These patients were treated with RFA (HALO90 ULTRA Ablation Catheter System; Covidien, GI Solutions, Sunnyvale, CA) at Ertan Digestive Disease Center at our tertiary University Hospital. Results: Seven patients underwent a total of 12 RFA procedures for treatment of refractory GAVE. The median number of RFA procedures was 2 (Range, 1 – 3). Average pre- and post-procedural hemoglobin were 9.3 g/dL and 10.16 g/dL, respectively. Five of seven patients (71 %) were transfusion-free after the RFA treatments while two patients continued to require blood transfusions. There were no complications in this series. Conclusion: RFA can be an effective alternative to APC for treatment of GAVE refractory to previous endoscopic therapy. Additional studies are needed to identify which subset of patients will benefit the most with RFA treatment.

New Indications for Endoscopic Radiofrequency Ablation

“…21 In addition, endoscopic RFA required fewer treatment sessions for clinical or endoscopic resolution as compared with APC (a difference of 1.27 endoscopies per successfully treated patient) ( Table 2). [16][17][18][19][21][22][23] Furthermore, both APC and RFA achieved similar increases in mean hemoglobin level; the number of complications also was similar across the 2 modalities. Although only a limited number of studies have been performed to evaluate RFA for the treatment of GAVE (6 RFA studies were included in this meta-analysis), likely in part owing to the novelty of the procedure for this pathology, available evidence suggests that RFA may possess a better efficacy and tolerability compared with APC.…”

“…In this study of 24 patients, 23 of whom were transfusion-dependent, the mean number of red cell units transfused decreased in all transfusiondependent patients (mean, 10.6 AE 12.1 before RFA compared with 2.5 AE 5.9 at 6 mo after RFA; P < .001). A more recent case series of 7 patients by Jana et al 19 found endoscopic RFA to be an effective alternative to APC for the treatment of GAVE in patients refractory to previous endoscopic therapy. Although a limited number of patients were enrolled and a median number of 2 RFA sessions produced a modest improvement in hemoglobin level after the procedure, 71% of patients (5 of 7) were no longer transfusion-dependent, with no immediate complications reported.…”

Radiofrequency Ablation for Treatment of Refractory Gastric Antral Vascular Ectasia: A Systematic Review of the Literature

“…The first study, conducted on 7 patients treated with the HALO ULTRA system, showed technical and clinical effectiveness in all patients with a mean gain of hemoglobin from 9.3 to 10.1 g/dL during a median follow-up of 6 months, in the absence of adverse events [ 26 ].…”

Case series on multimodal endoscopic therapy for gastric antral vascular ectasia, a tertiary center experience

“…Endoscopic therapies have rapidly become the mainstays of first line therapy namely with argon plasma coagulation (APC) as the most common modality and more recently with radiofrequency ablation (RFA) using Halo 90 catheter[ 9 ] and endoscopic band ligation (EBL) both of which have been shown to be safe and effective for GAVE treatment[ 10 , 11 ]. The latter two have been utilized in treatment of severe, diffuse, APC refractory GAVE[ 10 , 21 ]. Furthermore, there has been the advent of BARR χ Through The Scope technique (Covidien, TTS-1100) for RFA, which posits some advantages over the traditional Halo 90 system.…”