Radiofrequency ablation for the treatment of gastric antral vascular ectasia

Background and study aims: The traditional endoscopic treatment for gastric antral vascular ectasia (GAVE) is argon plasma coagulation, but results are not always positive. Radiofrequency ablation (RFA) is a new endoscopic therapy that may be an attractive option for the treatment of GAVE. The aim of this study was to assess the efficacy and safety of RFA for the treatment of GAVE.

Patients and methods: This was an open-label, retrospective, case series study. The main outcome measures were number of red blood cell (RBC) packs transfused (transfusion requirement) and hemoglobin concentrations (g/dL) in the 6 months prior to and after RFA. Success was defined as a decrease in transfusion requirement in the 6 months after RFA compared with before treatment.

Results: A total of 24 patients underwent a mean of 1.8 ± 0.8 RFA sessions. No complications were reported. One patient was referred for additional argon plasma coagulation during follow-up. The mean number of RBC packs decreased in all 23 transfusion-dependent patients, from a mean of 10.6 ± 12.1 during the 6 months prior to RFA, to a mean of 2.5 ± 5.9 during the 6 months after RFA treatment (P < 0.001), and 15 patients (65.2 %) were weaned off transfusions completely. An increase in the hemoglobin concentration was reported in all patients after RFA (from 6.8 ± 1.4 g/dL to 9.8 ± 1.8 g/dL; P < 0.001).

Conclusion: RFA for the treatment of GAVE seems feasible and safe, and significantly reduced the need for RBC transfusion and increased the hemoglobin level in this retrospective case series.

• References

• 1 Sebastian S, O’Morain CA, Buckley MJM. Review article: current therapeutic options for gastric antral vascular ectasia. Aliment Pharmacol Ther 2003; 18: 157-165
• 2 Gross SA, Al-Haddad M, Gill KRS et al. Endoscopic mucosal ablation for the treatment of gastric antral vascular ectasia with the HALO90 system: a pilot study. Gastrointest Endosc 2008; 67: 324-327
• 3 McGorisk T, Krishnan K, Keefer L et al. Radiofrequency ablation for refractory gastric antral vascular ectasia (with video). Gastrointest Endosc 2013; 78: 584-588
• 4 Selinger CP, Ang YS. Gastric antral vascular ectasia (GAVE): an update on clinical presentation, pathophysiology and treatment. Digestion 2008; 77: 131-137
• 5 Dulai GS, Jensen DM. Treatment of watermelon stomach. Curr Treat Options Gastroenterol 2006; 9: 175-180
• 6 Shibukawa G, Irisawa A, Sakamoto N et al. Gastric antral vascular ectasia (GAVE) associated with systemic sclerosis: relapse after endoscopic treatment by argon plasma coagulation. Intern Med 2007; 46: 279-283
• 7 Yusoff I, Brennan F, Ormonde D et al. Argon plasma coagulation for treatment of watermelon stomach. Endoscopy 2002; 34: 407-410
• 8 Chaves DM, Sakai P, Oliveira CV et al. Watermelon stomach: clinical aspects and treatment with argon plasma coagulation. Arq Gastroenterol 2006; 43: 191-195
• 9 Herrera S, Bordas JM, Llach J et al. The beneficial effects of argon plasma coagulation in the management of different types of gastric vascular ectasia lesions in patients admitted for GI hemorrhage. Gastrointest Endosc 2008; 68: 440-446
• 10 Gostout CJ, Viggiano TR, Ahlquist DA et al. The clinical and endoscopic spectrum of the watermelon stomach. J Clin Gastroenterol 1992; 15: 256-263
• 11 Bjorkman DJ, Buchi KN. Endoscopic laser therapy of the watermelon stomach. Lasers Surg Med 1992; 12: 478-481
• 12 Liberski SM, McGarrity TJ, Hartle RJ et al. The watermelon stomach: long-term outcome in patients treated with Nd:YAG laser therapy. Gastrointest Endosc 1994; 40: 584-587
• 13 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: 403-406
• 14 Kruger R, Ryan ME, Dickson KB et al. Diffuse vascular ectasia of the gastric antrum. Am J Gastroenterol 1987; 82: 421-426
• 15 Spahr L, Villeneuve JP, Dufresne MP et al. Gastric antral vascular ectasia in cirrhotic patients: absence of relation with portal hypertension. Gut 1999; 44: 739-742
• 16 Rustagi T, Corbett FS, Mashimo H. Treatment of chronic radiation proctopathy with radiofrequency ablation (with video). In press 2014. Gastrointest Endosc