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doi:10.1111/jgh.12568
E D U C AT I O N A N D I M A G I N G
Gastrointestinal: Radiofrequency ablation in the management of refractory gastric antral vascular ectasia
Figure 1 Endoscopic radiofrequency ablation of GAVE in cirrhosis (A) Gastric antral vascular ectasia prior to treatment (B) Application of probe over the lesions.
astric antral vascular ectasia (GAVE) rarely presents with refractory chronic blood loss. In the management of GAVE related blood loss, various endoscopic methods have been described with varying success, including band ligation, thermal ablation and argon plasma coagulation (APC). Despite all these, GAVE may result in refractory blood loss. A 66-year-old woman, diagnosed case of autoimmune hepatitis related cirrhosis and GAVE presented with chronic blood loss and severe anemia (Hemoglobin (Hb)—8.0g/dl) requiring multiple blood transfusions. She had undergone multiple sessions of treatment with APC without significant response. We applied the HALO90 radiofrequency ablation (RFA, BARRX Medical, Sunnyvale, CA) system for ablation of GAVE. An energy density of 12 J/cm2 (4 pulses/site) was applied, the procedure took 14 minutes to complete and there were no complications. After a single session of RFA the endoscopic appearance improved dramatically (Figures 1 and 2) with improvement in Hb (10.5 g/dl after 4 weeks). She underwent a repeat session 4 weeks later and after 1 month of second session, she had Hb of 12.0 g/dl.
894
Figure 2 Endoscopic view after the radiofrequency application (A) Endoscopic view immediately after the procedure (B) Endoscopic view after 4 weeks of follow up showing resolution of gastric antral lesions.
So far in literature there is only one pilot study that has reported the application of RFA in GAVE. Gross et al applied HALO90 system successfully in six patients with GAVE, bleeding, and blood transfusion dependence, where all patients showed significant improvement in Hb. RFA delivers controlled, high power density that covers larger area and are more effective than APC in diffuse lesions. The broader area covered during a single application, helps to avoid the bleeding risk unlike with the other “point and shoot methods”. More stable apposition during ablation helps in maintaining mucosal contact during peristaltic contractions in antrum. The superficial ablation (
doi:10.1111/jgh.12568
E D U C AT I O N A N D I M A G I N G
Gastrointestinal: Radiofrequency ablation in the management of refractory gastric antral vascular ectasia
Figure 1 Endoscopic radiofrequency ablation of GAVE in cirrhosis (A) Gastric antral vascular ectasia prior to treatment (B) Application of probe over the lesions.
astric antral vascular ectasia (GAVE) rarely presents with refractory chronic blood loss. In the management of GAVE related blood loss, various endoscopic methods have been described with varying success, including band ligation, thermal ablation and argon plasma coagulation (APC). Despite all these, GAVE may result in refractory blood loss. A 66-year-old woman, diagnosed case of autoimmune hepatitis related cirrhosis and GAVE presented with chronic blood loss and severe anemia (Hemoglobin (Hb)—8.0g/dl) requiring multiple blood transfusions. She had undergone multiple sessions of treatment with APC without significant response. We applied the HALO90 radiofrequency ablation (RFA, BARRX Medical, Sunnyvale, CA) system for ablation of GAVE. An energy density of 12 J/cm2 (4 pulses/site) was applied, the procedure took 14 minutes to complete and there were no complications. After a single session of RFA the endoscopic appearance improved dramatically (Figures 1 and 2) with improvement in Hb (10.5 g/dl after 4 weeks). She underwent a repeat session 4 weeks later and after 1 month of second session, she had Hb of 12.0 g/dl.
894
Figure 2 Endoscopic view after the radiofrequency application (A) Endoscopic view immediately after the procedure (B) Endoscopic view after 4 weeks of follow up showing resolution of gastric antral lesions.
So far in literature there is only one pilot study that has reported the application of RFA in GAVE. Gross et al applied HALO90 system successfully in six patients with GAVE, bleeding, and blood transfusion dependence, where all patients showed significant improvement in Hb. RFA delivers controlled, high power density that covers larger area and are more effective than APC in diffuse lesions. The broader area covered during a single application, helps to avoid the bleeding risk unlike with the other “point and shoot methods”. More stable apposition during ablation helps in maintaining mucosal contact during peristaltic contractions in antrum. The superficial ablation (
