Endoscopic Cryotherapy for the Management of Gastric Antral Vascular Ectasia (GAVE): A Pilot Study

Abstract

Background: Gastric antral vascular ectasia (GAVE) is an uncommon cause of upper gastrointestinal bleeding (UGIB). Thermal coagulation is currently the most commonly used form of endoscopic treatment. However there is a significant failure rate and often multiple sessions are required for the treatment of large areas of GAVE. The aim of this study was to investigate the safety and efficacy of novel endoscopic treatment for GAVE, cryotherapy. Methods: Prospective assessment of patients who had endoscopically confirmed GAVE and clinical evidence of UGIB was performed. 9 patients (7F,2M) underwent 3 endoscopic treatments with cryotherapy timed 3-6 weeks apart. Treatment procedures were performed using the Polar Wand TM cryogenic carbon dioxide delivery system with a catheter through the standard endoscope channel. All patients had an overtube inserted into the stomach for ventilation of gas. The patients were monitored for visible or biochemical evidence of UGIB, and the follow-up gastroscopy was performed for assessment. A complete response to treatment was defined as improvement in endoscopic appearance with raising hemoglobin without transfusion requirement. Results: 6/9 patients had a complete response to the treatment and 3/9 had a partial response. 8/9 patients had previously failed on argon plasma coagulation treatment. The average duration of the procedure was 26 minutes and the cryotherapy was 5 minutes. There were no immediate or delayed complications. Conclusions: Endoscopic cryotherapy is a safe and effective treatment for UGIB from GAVE. It appears to be effective even for the lesions refractory to argon plasma coagulation. A randomized controlled trial comparing the two modalities should be considered.