Endoscopic cryotherapy for the management of gastric antral vascular ectasia.
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.
Cho
Sarah
S
The Centre for Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Zanati
Simon
S
Yong
Elaine
E
Cirocco
Maria
M
Kandel
Gabor
G
Kortan
Paul
P
May
Gary
G
Marcon
Norman
N
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