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

Abstract

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.