title: Endoscopic cryotherapy for the management of gastric antral vascular ectasia.
abstract: BACKGROUND
  Gastric antral vascular ectasia (GAVE) is an uncommon but clinically significant cause of chronic GI bleeding.
  
  
  OBJECTIVE
  To assess the efficacy and safety of cryotherapy for endoscopic treatment of GAVE.
  
  
  METHODS
  Patients received 3 sessions of endoscopic cryotherapy at 3-week to 6-week intervals and had a follow-up endoscopy 4 weeks thereafter. They were followed prospectively in terms of clinical and endoscopic response.
  
  
  METHODS
  Tertiary-care center, between October 2004 and April 2006.
  
  
  METHODS
  The patients were 43 to 89 years of age, with a diagnosis of GAVE and documented iron deficiency anemia. Eight patients had a history of overt GI bleeding. Eight patients (67%) had previously been treated with argon plasma coagulation (APC) (median 6 sessions, range 1-10 sessions) and failed to respond or had a recurrence.
  
  
  RESULTS
  Twelve patients were enrolled. Six patients (50%) had a complete response, and 6 patients had a partial response. The mean number of units of blood transfused in the period of 3 months before cryotherapy and during the period of follow-up of 3 months was 4.6 and 1.7 units, respectively. An increased mean Hb level, from 9.9 to 11.3 g/dL, was noted. The average duration of the cryotherapy was 5 minutes (range 1-15 minutes). In 32 of 36 cryotherapy treatment sessions performed (89%), it was technically possible to treat more than 90% of GAVE lesions. There were no immediate cryotherapy-related complications, and none of the patients required admission after the procedure.
  
  
  CONCLUSIONS
  A pilot study from a single center.
  
  
  CONCLUSIONS
  Endoscopic cryotherapy is a safe and effective treatment for GAVE. It appears to be effective, even for GAVE refractory to APC therapy. Optimal cryogen, delivery device, and treatment protocols are yet to be determined.
authors.affiliation: The Centre for Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cho
authors.forename: Simon
authors.initials: S
authors.lastname: Zanati
authors.forename: Elaine
authors.initials: E
authors.lastname: Yong
authors.forename: Maria
authors.initials: M
authors.lastname: Cirocco
authors.forename: Gabor
authors.initials: G
authors.lastname: Kandel
authors.forename: Paul
authors.initials: P
authors.lastname: Kortan
authors.forename: Gary
authors.initials: G
authors.lastname: May
authors.forename: Norman
authors.initials: N
authors.lastname: Marcon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology; D017679:Cryotherapy; D005260:Female; D020252:Gastric Antral Vascular Ectasia / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged