Endoscopic cryotherapy for the management of gastric antral vascular ectasia

Sarah Cho, Simon Zanati, Elaine Yong, Maria Cirocco, Gabor Kandel, Paul Kortan, Gary May, Norman Marcon

Research output: Contribution to journalArticle

Abstract

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. Design: 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. Setting: Tertiary-care center, between October 2004 and April 2006. Patients: 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. Limitations: 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.

Original languageEnglish (US)
Pages (from-to)895-902
Number of pages8
JournalGastrointestinal Endoscopy
Volume68
Issue number5
DOIs
StatePublished - Nov 2008
Externally publishedYes

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Gastric Antral Vascular Ectasia
Cryotherapy
Argon Plasma Coagulation
Hemorrhage
Iron-Deficiency Anemias
Patient Admission
Therapeutics
Clinical Protocols
Tertiary Care Centers
Endoscopy
Safety

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Cho, S., Zanati, S., Yong, E., Cirocco, M., Kandel, G., Kortan, P., ... Marcon, N. (2008). Endoscopic cryotherapy for the management of gastric antral vascular ectasia. Gastrointestinal Endoscopy, 68(5), 895-902. https://doi.org/10.1016/j.gie.2008.03.1109

Endoscopic cryotherapy for the management of gastric antral vascular ectasia. / Cho, Sarah; Zanati, Simon; Yong, Elaine; Cirocco, Maria; Kandel, Gabor; Kortan, Paul; May, Gary; Marcon, Norman.

In: Gastrointestinal Endoscopy, Vol. 68, No. 5, 11.2008, p. 895-902.

Research output: Contribution to journalArticle

Cho, S, Zanati, S, Yong, E, Cirocco, M, Kandel, G, Kortan, P, May, G & Marcon, N 2008, 'Endoscopic cryotherapy for the management of gastric antral vascular ectasia', Gastrointestinal Endoscopy, vol. 68, no. 5, pp. 895-902. https://doi.org/10.1016/j.gie.2008.03.1109
Cho, Sarah ; Zanati, Simon ; Yong, Elaine ; Cirocco, Maria ; Kandel, Gabor ; Kortan, Paul ; May, Gary ; Marcon, Norman. / Endoscopic cryotherapy for the management of gastric antral vascular ectasia. In: Gastrointestinal Endoscopy. 2008 ; Vol. 68, No. 5. pp. 895-902.
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AU - May, Gary

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AB - 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. Design: 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. Setting: Tertiary-care center, between October 2004 and April 2006. Patients: 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. Limitations: 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.

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