Radiofrequency ablation for gastric antral vascular ectasia and radiation proctitis

Abstract

Gastric antral vascular ectasia (GAVE) and chronic radiation proctitis (CRP) are well-known causes of repeated gastrointestinal bleeding and iron deficiency anemia. Argon plasma coagulation (APC) is the most common endoscopic therapy used, but some patients need multiple APC sessions. Radiofrequency ablation (RFA) is recently used in GAVE and CRP treatment with promising results. In this case series, we analyzed data for 15 patients with GAVE and 5 patients with CRP that had multiple prior APC treatment. They were treated with RFA HALO 90 catheter (HALO90 Ablation Catheter System; Covidien, GI Solutions, Sunnyvale, CA) in our tertiary referral center. A total of 20 patients received 32 RFA procedures (8 in the CRP group and 24 in the GAVE group). The median number of the procedures was 2 (range 1-4). The hemoglobin levels in the GAVE group were 83 g/L pre-RFA and 98 g/L post-RFA and in the CRP group, 86 g/L pre-RFA and 103 g/L post-RFA. A total of 16/20 patients (80%) were transfusion-free after the completion of RFA treatment. Technical success of the treatment was 95% (19/20 patients). RFA can be safely and successfully used in APC refractory GAVE and CRP patients.

Efficacy and safety of radiofrequency ablation for treatment of chronic radiation proctitis: A systematic review and meta‐analysis

“…This systematic review and meta‐analysis included a total of six studies ( n = 71) . A PRISMA flowchart of search results is shown in Figure .…”

“…This systematic review and meta-analysis included a total of six studies (n = 71). 15,[19][20][21][22][23] A PRISMA flowchart of search results is shown in Figure 1. Four prospective studies and two retrospective studies were analyzed.…”

“…Radiofrequency ablation was first utilized in treatment of CRP in 2009 . Since that time, multiple small studies have reported RFA to be safe and effective for management of CRP . Reasons to explain this exploration of RFA as an alternative treatment include the realization that there are several advantages of RFA as compared with other thermal methods.…”

“…15 Since that time, multiple small studies have reported RFA to be safe and effective for management of CRP. [19][20][21][22][23] Reasons to explain this exploration of RFA as an alternative treatment include the realization that there are several advantages of RFA as compared with other thermal methods. RFA allows limited and focused energy penetration, thus restricting damage to superficial mucosa as compared with other thermal methods.…”

New Indications for Endoscopic Radiofrequency Ablation

“…Table 3 includes important baseline characteristics of studies evaluating RFA for the treatment of CRP. [26][27][28][29][30] Based on these studies, endoscopic RFA appears to a promising modality capable of providing a firstor second-line treatment option for patients with CRP.…”