Radiofrequency ablation may treat gastric antral vascular atresia

1. In 23 transfusion-dependent patients who underwent radiofrequency ablation for gastric antral vascular atresia, all experienced a decrease in transfusion requirement, with 15 (65%) no longer requiring transfusion after ablation therapy. 

2. All patients experienced an increase in hemoglobin concentration after therapy. 

Evidence Rating Level: 4 (Poor) 

Study Rundown: Gastric antral vascular atresia (GAVE) is a rare cause of gastrointestinal bleeding and subsequent anemia. Argon plasma coagulation (APC) is currently the first line therapy but its limited efficacy (2/3 of patients still are dependent on blood transfusions post therapy) has prompted exploration of other treatment modalities. Radiofrequency ablation (RFA) was first attempted for the treatment of GAVE in 2008 in a limited cohort and the authors of this study sought to explore the feasibility, efficacy, and safety of RFA in a larger patient population. Their findings, which include increased hemoglobin levels, decreased transfusion requirements in all patients, and no reported complications, provide evidence for RFA as a safe and effective alternative in the treatment of GAVE. However, as a case series, the efficacy of RFA relative to current first line therapy, APC, could note be assessed due to lack of any comparison group. Other limitations include a small sample size, limited time of follow-up, and a lack of standardization in the application of RFA therapy.

Click to read the study in Endoscopy

Relevant Reading: Endoscopic mucosal ablation for the treatment of gastric antral vascular ectasia with the HALO90 system: a pilot study

In-Depth [retrospective case series]:  A total of 24 patients from 8 academic centers were reviewed for the study. Patients received an average of 1.8 (range 1-3) RFA sessions with a mean duration of 48 minutes per session (range 20-140). Data related to the number of red blood cell (RBC) transfusion packs and hemoglobin concentration was collected in the 6-month periods preceding and following RFA therapy.  Among 23 transfusion-dependent patients, transfusion needs decreased from 6.0 ± 12.1 (range 1-47) RBC packs in the 6 months before RFA to 2.5 ± 5.9 (range 0-27) RBC packs following therapy (p<0.001). Of these patients, 15 (65%) were weaned off transfusions completely post RFA. Hemoglobin concentration [Hb] additionally increased in all 24 patients after RFA, with an increase in mean [Hb] from 6.8 ± 1.4 g/dL to 9.8 ± 1.8 g/ dL (p<0.001).No perioperative or post-operative complications were noted up to 6 months following therapy.

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