RADIOFREQUENCY ABLATION USING BARRX FOR THE ENDOSCOPIC TREATMENT OF GASTRIC ANTRAL VASCULAR ECTASIA (GAVE) AND RADIATION PROCTITIS: A SINGLE CENTRE EXPERIENCE

Aims Radiofrequency ablation (RFA) is a new endoscopic technique recently introduced to treat gastric antral vascular ectasia (GAVE) and chronic radiation proctitis. Data from literature are limited for samples, treatment schedule and costs. We here assess safety and efficacy of RFA in these patients.

Methods From January 2016 to November 2018 all patients with GAVE and radiation proctitis were enrolled at our Endoscopic Unit: clinical and endoscopic data were collected.

Results 44 patients (mean age 74 years) were treated with RFA by the HALO system (38 with transfusion dependent GAVE (28/38 cirrhotics, 22/38 refractory to argon plasma coagulation) and and 6 with chronic radiation proctitis) for a total of 74 procedures. The technique is easy to perform after adequate training and very well tolerated. Side effects occurred in 3.1 % of treated cases. Averall, 93% (41/44) of the patients had cessation of bleeding after 1-4 treatments (mean 1.7, follow up 6-27 months), performed every 8 weeks until complete endoscopic eradication. Mean number of red blood cells transfusion significantly decreased (1.7 vs 19.1 units, p< 0.0001) with significant increase of hemoglobin level (11.1 vs 7.3 g/dl, p>0.0001). The treatment was cost-effective (mean 574.036 euros before vs 25.078 euros post treatment).

Conclusions In our experience RFA ablation is a safe and effective endoscopic tool for the treatment of GAVE and radiation proctitis, and it should become the first-line treatment in this setting.