REFRACTORY GAVE TREATED WITH RADIOFREQUENCY ABLATION BY THROUGH-THE-SCOPE CATHETER: THREE CASES OF COMPLETE RESPONSE

Aims:

Gastric antral vascular ectasia (GAVE), or watermelon stomach, is an uncommon cause of upper gastrointestinal bleeding. One emerging and promising endoscopic treatment for GAVE is radiofrequency ablation (RFA) with focal catheters (e.g.HALO⁹⁰and HALO^ULTRA). We present three cases of refractory GAVE treated with radiofrequency ablation with the smaller and more handling through-the-scope (TTS) catheter, with long-term response.

Methods:

Three patients (1^st patient male 68 years old, 2^nd patient male 81 years old, 3^rd patient female 71 years old) with endoscopic and histological diagnosis of GAVE and chronic anemia dependent on blood transfusions, previously treated with argon plasma coagulation or endoscopic band ligation without clinical response, underwent RFA with the Barrx through-the-scope catheter. Every session was performed placing the device at 12 or 6 o'clock, starting at the pylorus and working proximally providing a maximum of 2 hits in the same area with an energy density of 12J/cm². The average duration of each session was 35 minutes, with a number of applications ranging from 60 to 80.

Results:

The 1^st and the 2^nd patients were treated with two sessions while the 3^rdpatient with 3 sessions of RFA. Every session reached a full technical success without any complication during or after the procedure. After a mean follow-up of 9 months, in each of the 3 cases Hemoglobin rose by at least 2 g/dl with values above the threshold of 10 g/dl and no further transfusion has been required confirming a good clinical outcome.

Conclusions:

Radiofrequency ablation with the Barrx is a new, promising technique for endoscopic treatment of GAVE. Current evidence supports its effectiveness, in the absence of major adverse events. In contrast to other reports, we used the through-the-scope RFA catheter since it is more handy and can be inserted through the working channel providing a better maneuverability and avoiding multiple endoscope introductions.