Radiofrequency Ablation for Treatment of Refractory Gastric Antral Vascular Ectasia

Abstract

Purpose: Gastric antral vascular ectasia (GAVE) is a known cause of gastrointestinal bleeding and chronic iron deficiency anemia. Endoscopic therapy with argon plasma coagulation (APC) is widely used for treatment of GAVE, but a majority of patients continue to require repeated blood transfusions and multiple endoscopic procedures (refractory GAVE). We describe our experience with the use of radiofrequency ablation (RFA) therapy in treating patients with refractory GAVE. Methods: Prospective case series of seven patients with refractory GAVE who were treated with RFA (HALO90 ULTRA Ablation Catheter System; Covidien, GI Solutions, Sunnyvale, CA). Results: Seven patients (one male, six females, mean age of 69 years, range 56-82) underwent RFA for treatment of refractory GAVE (12 total procedures). All of the patients had previously undergone endoscopic therapy with APC. 4 (57%) of the seven required multiple RFA treatments. Average pre- and post-procedural hemoglobin were 9.3 (SD 0.78) and 10.16 (SD 1.72; p >0.05), respectively. Two (29%) of the seven patients required post-procedural transfusions. Conclusion: Radiofrequency ablation is an effective alternative to APC for treatment of GAVE refractory to previous endoscopic therapy. Five (71%) of seven patients are transfusion-free after the RFA treatment. Further studies are needed to identify which subset of patients will benefit the most with RFA treatment.Table 1: Patient demographics