Radiofrequency ablation for patients with refractory symptomatic anaemia secondary to gastric antral vascular ectasia

Abstract

Background: Gastric antral vascular ectasia (GAVE) is a rare cause of gastrointestinal bleeding, often causing iron deficiency anaemia. Previous studies have looked at the management of this with argon plasma coagulation, laser therapy and endoscopic band ligation. Methods: This was a single-centre prospective study to evaluate the efficacy and safety of radiofrequency ablation (RFA) in patients with GAVE with persistent anaemia refractory to at least one session of first-line endoscopic therapy. Patients were treated with a through-the-scope (TTS) radiofrequency catheter at two endoscopic sessions six weeks apart. The primary outcome was change in haemoglobin at six months posttreatment. The secondary outcomes were reduction in blood or iron requirements, endoscopic surface area regression and complications. Results: Twenty patients were treated. The mean change in haemoglobin at six months was þ12.6 g/l (95% confidence interval 11.7-24.3 g/l), paired t test p < 0.001. At six months, three of 14 individuals who had required blood transfusions had ongoing blood transfusions and five of 17 who had required iron had ongoing iron needs. Surface area regression was scored as 74% AE 25% but no correlation was seen between this and other outcomes. Three of 20 patients experienced pain which was managed with oral analgesia. Of the 14 patients who had reached 12-month follow-up, three required retreatment (21%). Discussion: This small study suggests that RFA is a safe and effective treatment for GAVE. Our study uses the TTS catheter compared to other studies, and demonstrates prolonged improvement in haemoglobin and reduction in blood and iron requirements with a novel assessment of surface area regression.

Is Endoscopic Band Ligation a Superior Treatment Modality for Gastric Antral Vascular Ectasia Compared to Argon Plasma Coagulation?

“…Nonetheless, the proportion of associated conditions reported are similar to those in recent studies assessing therapeutic intervention in GAVE. 18 The lower proportion of cirrhosis in our study may be explained by: (1) over-diagnosis of GAVE in cirrhotic patients with portal hypertensive gastropathy, and (2) cirrhotic patients with GAVE may represent a milder form and were not considered for therapy.…”

“…[13][14][15][16] Radiofrequency ablation (RFA), which transmits high-power energy in short bursts to ablate superficial mucosal lesions, has been proposed as an alternative to APC, particularly for treatment-refractory cases. 17,18 However, there are few prospective trials investigating RFA in GAVE with sparse data on long-term outcomes. Endoscopic band ligation (EBL) has become an increasingly used alternative treatment modality, 19 demonstrating a good safety profile and favourable effectiveness.…”

The cost-effectiveness of radiofrequency ablation for treating patients with gastric antral vascular ectasia refractory to first line endoscopic therapy

“…As APC has been found to be effective in only about 30% of cases 20 , there is a need for an alternative therapy to reduce blood and iron transfusion requirements 8 and thereby improve quality of life in patients with GAVE. RFA has already been shown to be effective in the treatment of GAVE 25,26 . The model estimates that use of RFA for the aforementioned patient population is likely to be cost-effective in the UK when compared with APC.…”

“…This technique transmits high power energy for a short period of time to ablate tissue in the gastrointestinal tract. RFA has been used in patients for the treatment of GAVE, showing improvements in haemoglobin and reductions in transfusion requirements in patients refractory to APC without complications 25,26 .…”

Radiological findings in gastrointestinal scleroderma

“…5 GAVE is treated conservatively, with iron supplementationl and blood transfusions, or endoscopically with argon plasma coagulation (APC) or radiofrequency ablation (RFA). 17,20…”