CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(03): E266-E270
DOI: 10.1055/s-0043-123187
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Radiofrequency ablation (RFA) vs. argon plasma coagulation (APC) for the management of gastric antral vascular ectasia (GAVE) in patients with and without cirrhosis: results from a retrospective analysis of a large cohort of patients treated at a single center

Paul St Romain
Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, United States
,
Amanda Boyd
Division of Internal Medicine, Duke University Medical Center, Durham, North Carolina, United States
,
Jiayin Zheng
Division of Biostatistics, Duke University Medical Center, Durham, North Carolina, United States
,
Shein-Chung Chow
Division of Biostatistics, Duke University Medical Center, Durham, North Carolina, United States
,
Rebecca Burbridge
Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, United States
,
Daniel Wild
Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, United States
› Author Affiliations
Further Information

Publication History

submitted 25 August 2017

accepted after revision 08 November 2017

Publication Date:
28 February 2018 (online)

Abstract

Introduction and study aims Gastric antral vascular ectasia (GAVE) is a mucosal abnormality associated with multiple conditions, most notably cirrhosis and systemic sclerosis, that causes indolent gastrointestinal bleeding. It is primarily managed with endoscopic therapy. Traditionally, GAVE is endoscopically ablated using argon plasma coagulation (APC) but radiofrequency ablation (RFA) is emerging as an alternative modality. No prior comparison of the 2 modalities has been published.

We retrospectively compared the effects of GAVE ablation with either RFA, APC or both in the largest cohort of patients thus far presented. We also attempt to discern what effect concomitant cirrhosis has on response to treatment.

Patients and methods After receiving IRB approval, we reviewed our electronic health records to identify all patients who underwent endoscopic evaluation for GAVE between January, 2011 and October, 2016. We compared important variables between APC and RFA, as well as between cirrhosis and non-cirrhosis, using the Chi-square test and the Wilcoxon two-sample test as appropriate.

Results During our study period, 81 patients were endoscopically evaluated for GAVE. 24 patients were treated with APC alone, 28 with RFA alone and 25 patients received both treatment modalities.

APC-treated patients underwent a mean of 2.4 treatment sessions with a mean of 205 days between treatments. RFA-treated patients underwent a mean of 2.3 treatment sessions with a mean of 100 days between treatments.

Hemoglobin values remained stable or increased in all patients during our study period and there were no significant differences in Hgb trend between those treated with APC and those with RFA.

Conclusions RFA and APC were both effective in treating bleeding from GAVE. Though we found subtle differences, patients underwent a similar number of treatment sessions and had similar procedure times and a similar time between sessions no matter the treatment modality used.