title: Radiofrequency ablation for refractory gastric antral vascular ectasia (with video).
abstract: 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.
  
  
  METHODS
  Open-label prospective cohort study of patients with GAVE refractory to APC.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  GAVE patients with previous failed APC therapy, chronic anemia, and transfusion dependence.
  
  
  METHODS
  Endoscopic RFA to the gastric antrum using the HALO(90) ULTRA ablation catheter until transfusion independence is achieved or a maximum of 4 sessions are performed.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Single-center, single-operator, and nonrandomized design.
  
  
  CONCLUSIONS
  RFA is safe and effective for treating patients with refractory GAVE after attempted APC.
authors: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors: Tim
authors: T
authors: McGorisk
authors: Kumar
authors: K
authors: Krishnan
authors: Laurie
authors: L
authors: Keefer
authors: Srinadh
authors: S
authors: Komanduri
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D057908:Argon Plasma Coagulation; D001803:Blood Transfusion; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D020252:Gastric Antral Vascular Ectasia / Q000150:complications / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000601:surgery*; D012008:Recurrence; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: APC; CS; GAVE; RFA; argon plasma coagulation; clinical success; gastric antral vascular ectasia; radiofrequency ablation