617 Outcomes of Patients With Small Bowel Angiodysplasia Treated With a Small Bowel Radiofrequency Ablation Catheter: A Multicenter Case Series

Abstract

INTRODUCTION: Small bowel angioectasia (SBA) are the most common cause of small bowel GI bleeding, usually treated with argon plasma coagulation (APC). Bleeding recurs in >40%. The outcomes of patients with SBA treated with a dedicated radiofrequency ablation catheter was reported. METHODS: Patients were treated using a commercially available small bowel radiofrequency ablation catheter (SBRFA) during enteroscopy which is 25 mm wide, 260 cm long, and the treatment paddle is 7.5 mm wide deployed, and 10 mm long. The paddle was advanced to the lesion, and gentle pressure was applied delivering 10 J/cm2 with each application. The same area could be treated twice. Patient demographics, pre and post treatment hemoglobin, time to recurrent bleeding, and need for repeated therapy were reported. RESULTS: 20 subjects were treated from March to October 2018: 6 females (age 68; SD 11.1) and 14 males (age 73; SD 10.4). Three subjects had a left ventricular assist device (LVAD). 19 (95%) had at least one previous EGD (total at least 43, range 1 to >10), and at least one previous colonoscopy (total 42, range 1 to >10). 14 subjects (70%) had an abnormal video capsule endoscopy; 14 (70%) had previous APC. Median hemoglobin before treatment was 8.3 g/dL (5.1-14.4), and 13 subjects (65%) had a mean of 4 (SD 2.1) units of blood transfused. A median of 23 SBA were treated (2 to 99 total). No other treatments such as APC were used. Median follow-up was 195 days (30-240). The most recent median hemoglobin in 15 subjects (75%) was 9.4 g/dL (5 to 13) (P = 0.04). Repeat endoscopy rate was 20%; once in 2 subjects (at 45 and 210 days after SBRFA), and twice in one subject (60 days after SBRFA treatment). One subject with LVAD had a repeat upper endoscopy and no treatment, one subject with GAVE had a push enteroscopy and no treatment, and the third subject with LVAD had two assisted enteroscopies: SBA were re-treated with APC once, and no treatment was needed the last time. One patient with an LVAD had overt ileum bleeding and underwent embolization. 2 subjects (10%) required repeat blood transfusion (2 units each). Two deaths at 60 and 180 days were unrelated to GIB. CONCLUSION: In this series of SBRFA therapy of SBA up to 240 days of follow up 3/20 subjects (15%) required repeat endoscopy. Repeated endotherapy was necessary in 1 subject. All subjects with LVAD had repeat procedures. 2 subjects required more blood transfusions. The data compares favorably to historical SBA outcomes but comparative studies are needed.