Treatment of Small Bowel Angiodysplasia Using a Novel Radiofrequency Ablation Device

Abstract

Introduction: Gastrointestinal angiodysplasia (GIAD) is the most common cause of small bowel bleeding. Argon plasma coagulation (APC) has been the preferred modality for the treatment of GIAD, though there are limitations to this method. The angulated small bowel can often hinder the passage of the APC catheter, impairing repeated re-insertion through the enteroscope. Additionally, targeting of lesions can be difficult with APC, resulting in incomplete ablation. There is also potential for significant intestinal insufflation during prolonged procedures, as argon gas flow is set at a rate of 0.5 to 2 liters/minute. Ideally, an instrument capable of repetitive use, covering more mucosal area per treatment with low risk of damage to healthy mucosa and improved ablation is desirable. Here we present a case series of 8 patients treated with a novel through-the-scope small bowel radiofrequency ablation (SB RFA) catheter that has many of these advantages over APC. Methods: This was an open label pilot study involving 8 patients with small bowel bleed from GIAD. Informed consent was obtained for the procedure. A novel SB RFA catheter (Medtronic, Minneapolis, MN) with a shaft diameter of 2.5 mm and length of 240 cm; at settings 10 J/cm2 was used to treat small bowel GIAD with an enteroscope with a double or single balloon overtube system (FUJIFILM Medical Systems, Wayne NJ, EN-450BI5, and TS-13140, or Olympus America, Center Valley, PA Olympus SIF Q180, and ST-SB1, respectively). Results: Hemostasis was achieved in all 8 cases. There were no procedural complications, and each lesion only needed 1 treatment. There was wide variation in the number of lesions treated in each procedure, ranging from 1 to 78. The performance characteristics of the SB RFA catheter were excellent, and the RFA catheter was felt to have better targeting and bleeding control than APC. Conclusion: This early pilot study demonstrates the safety and feasibility of a novel SB RFA catheter as a viable treatment modality for small bowel GIAD. Its advantages include a more durable shaft that can tolerate multiple re-insertions and the ability to rotate the catheter, which allows for direct targeting of the lesion. Additional studies are needed to compare this to conventional APC catheters, as well as establish long term durability of treatment.765_A Figure 1. Insertion of RFA catheter through enteroscope765_B Figure 2. Successful ablation of GIAD using RFA catheter