3503 Endoscopic cryotherapy: results of a pilot study for the treatment of mucosal vascular lesions in humans.

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Thermal therapy is the cornerstone of endoscopic treatment of mucosal disease of the gastrointestinal tract.We have recently described results of animal studies with a novel endoscopic device that delivers a freezing spray based on the Joules-Thompson effect (Gastrointes Endosc 1999;49:627-31). This device is simple, portable, inexpensive and uses compressed gas. We report the results of a pilot study using an improved version of the device to treat mucosal vascular lesions in humans. AIM: To determine the safety and efficacy of endoscopic cryotherapy to treat patients with mucosal vascular lesions and recurrent gastrointestinal bleeding. METHODS: Patients with recurrent GI bleeding from mucosal vascular lesions such as AVM's, watermelon stomach and radiation gastritis/proctitis who had failed conventional thermal therapy were recruited. Cryotherapy was applied to affected areas in sessions until all areas were treated. Follow-up endoscopy was performed 2-4 weeks after the final session in all patients. Serial hematocrits and blood transfusions requirements following therapy were recorded. RESULTS: 8 patients were recruited with gastric AVM's (n=5), watermelon stomach(n=1), radiation gastritis(n=1), radiation proctitis (n=1). There mean number of sessions for therapy was 3.25(mean range of 1-6 sessions). 6 patients had no further bleeding after a mean follow of 6.7±4.6 weeks. Follow-up endoscopy in these patients revealed normally regenerated mucosa. 2 patients continued to have bleeding despite cryotherapy, one had a watermelon stomach with refractory post-chemotherapy thromboctopenia and the second patient had radiation gastritis and maked debilitation from metastatic cancer. There were no complications noted in any of the 8 patients enrolled. CONCLUSIONS: This pilot study demonstrates that cryotherapy is safe and effective treatment for recurrent gastrointestinal bleeding from mucosal vascular lesions. Further controlled trials are needed.