Radiofrequency ablation for refractory gastric antral vascular ectasia (with video)

Background: Gastric antral vascular ectasia (GAVE) is a cause of upper GI bleeding and chronic anemia. Although upper endoscopy with argon plasma coagulation (APC) is an accepted therapy for GAVE, many patients continue to bleed and remain transfusion dependent after therapy. Radiofrequency ablation (RFA) may provide an alternative therapeutic option for GAVE. Objective: To determine the efficacy and safety of RFA for patients with GAVE who remain transfusion dependent after APC treatment. Design: Open-label prospective cohort study of patients with GAVE refractory to APC. Setting: Academic tertiary referral center. Patients: GAVE patients with previous failed APC therapy, chronic anemia, and transfusion dependence. Interventions: Endoscopic RFA to the gastric antrum using the HALO⁹⁰ ULTRA ablation catheter until transfusion independence is achieved or a maximum of 4 sessions are performed. Main Outcome Measurements: Transfusion requirements before and after RFA. Secondary outcomes are hemoglobin before and 6 months after RFA completion, number of RFA sessions, and complications. Results: Twenty-one patients underwent at least 1 RFA session with ablation of GAVE lesions. At 6 months after completion of the course of RFA therapy, 18 of 21 patients (86%) were transfusion independent. Mean hemoglobin increased from 7.8 to 10.2 in responders (n = 18). Two adverse events occurred (minor acute bleeding and superficial ulceration); both resolved without intervention. Limitations: Single-center, single-operator, and nonrandomized design. Conclusions: RFA is safe and effective for treating patients with refractory GAVE after attempted APC.