Radiofrequency Ablation Using HALO™ Ablation Catheter for Gastric Antral Vascular Ectasia: A Case Series from a Community Hospital

Abstract

Purpose: Gastric antral vascular ectasia (GAVE) is an infrequent cause of upper gastrointestinal bleeding, constituting 4% of non-variceal bleeds. Therapeutic options are limited which includes medical, endoscopic, and surgical treatment. We present this case series to evaluate the use of radiofrequency ablation (RFA) as a plausible option. Methods: We conducted a retrospective analysis of patients who underwent RFA for GAVE lesions at our institution. One patient underwent antrectomy 2 days after the first session of RFA and was therefore excluded from this study. One patient received first session of RFA recently and his post-treatment follow-up is not complete. For rest of the patients, their demographics, number of RFA sessions, type of catheter(s) used, total number of ablations and other treatment options used, hemoglobin (Hb) level, total number of blood transfusions required, and total number of days spent in the hospital due to anemia secondary to GAVE lesions before and after therapy were recorded. Results: A total of five (two male, three female) patients were included with a mean age of 81 years. Since one patient does not have complete follow-up after treatment, data pertaining to him is not used to make calculations. Both HALO90 and HALO90 Ultra were used. An average of 1.8 sessions (range 1-4) and 65 ablations (range 17-181) were applied per patient. After the completion of RFA, mean Hb increased from 9.13 gm/dL (range 7.6-11.6 gm/dL) to 11.05 gm/dL (range 9.3-11.75 gm/dL), the mean number of transfusions decreased from 41.25 units/patient (range 0-158) to 8.4 (range 0-10), and none of the patients were admitted to the hospital again with GI bleed or anemia after RFA. Two patients had no previous therapy while the other three had received multiple argon plasma coagulation (APC) sessions (3-13) prior to RFA. Only one patient received APC (two sessions) after RFA. Conclusion: RFA using HALO ablation catheter has been utilized safely in Barrett's Esophagus for ablation of metaplastic epithelium. Its use in GAVE lesions was first shown by Gross et al in 2007. Our case series evaluates the use of RFA in all the patients of GAVE lesions including those not responding to (APC). APC is the most studied and used form of treatment for GAVE, but it has a small surface area of 12 mm2 and hence has a small focal area of coverage. HALO90 and HALO90 Ultra have surface area of 260 mm2 and 520 mm2, respectively, and hence can be used to ablate larger surface areas. In our experience we found that all patients had an improvement in their Hb levels, blood transfusion requirements decreased markedly, and no one was admitted to hospital again with GI bleed or anemia. Our study shows benefits of RFA in GAVE lesions and this must be studied in a randomized controlled trial.