Radiofrequency ablation for patients with refractory symptomatic anaemia secondary to gastric antral vascular ectasia.
Endoscopy
gastric antral vascular ectasia
gastrointestinal bleeding
radiofrequency ablation
Journal
United European gastroenterology journal
ISSN: 2050-6406
Titre abrégé: United European Gastroenterol J
Pays: England
ID NLM: 101606807
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
23
07
2018
accepted:
28
10
2018
entrez:
14
5
2019
pubmed:
14
5
2019
medline:
14
5
2019
Statut:
ppublish
Résumé
Gastric antral vascular ectasia (GAVE) is a rare cause of gastrointestinal bleeding, often causing iron deficiency anaemia. Previous studies have looked at the management of this with argon plasma coagulation, laser therapy and endoscopic band ligation. This was a single-centre prospective study to evaluate the efficacy and safety of radiofrequency ablation (RFA) in patients with GAVE with persistent anaemia refractory to at least one session of first-line endoscopic therapy. Patients were treated with a through-the-scope (TTS) radiofrequency catheter at two endoscopic sessions six weeks apart. The primary outcome was change in haemoglobin at six months posttreatment. The secondary outcomes were reduction in blood or iron requirements, endoscopic surface area regression and complications. Twenty patients were treated. The mean change in haemoglobin at six months was +12.6 g/l (95% confidence interval 11.7-24.3 g/l), paired This small study suggests that RFA is a safe and effective treatment for GAVE. Our study uses the TTS catheter compared to other studies, and demonstrates prolonged improvement in haemoglobin and reduction in blood and iron requirements with a novel assessment of surface area regression.
Sections du résumé
Background
Gastric antral vascular ectasia (GAVE) is a rare cause of gastrointestinal bleeding, often causing iron deficiency anaemia. Previous studies have looked at the management of this with argon plasma coagulation, laser therapy and endoscopic band ligation.
Methods
This was a single-centre prospective study to evaluate the efficacy and safety of radiofrequency ablation (RFA) in patients with GAVE with persistent anaemia refractory to at least one session of first-line endoscopic therapy. Patients were treated with a through-the-scope (TTS) radiofrequency catheter at two endoscopic sessions six weeks apart. The primary outcome was change in haemoglobin at six months posttreatment. The secondary outcomes were reduction in blood or iron requirements, endoscopic surface area regression and complications.
Results
Twenty patients were treated. The mean change in haemoglobin at six months was +12.6 g/l (95% confidence interval 11.7-24.3 g/l), paired
Discussion
This small study suggests that RFA is a safe and effective treatment for GAVE. Our study uses the TTS catheter compared to other studies, and demonstrates prolonged improvement in haemoglobin and reduction in blood and iron requirements with a novel assessment of surface area regression.
Identifiants
pubmed: 31080606
doi: 10.1177/2050640618814659
pii: 10.1177_2050640618814659
pmc: PMC6498795
doi:
Types de publication
Journal Article
Langues
eng
Pagination
217-224Références
Dig Dis Sci. 1989 Jun;34(6):885-8
pubmed: 2721320
J R Soc Med. 1993 Jan;86(1):52
pubmed: 8423582
Gastroenterology. 1984 Nov;87(5):1165-70
pubmed: 6332757
Frontline Gastroenterol. 2018 Apr;9(2):98-104
pubmed: 29588836
World J Gastrointest Endosc. 2013 Jan 16;5(1):6-13
pubmed: 23330048
Endoscopy. 2007 Feb;39 Suppl 1:E320
pubmed: 18273773
Lasers Med Sci. 2004;18(4):213-8
pubmed: 15042426
United European Gastroenterol J. 2016 Jun;4(3):423-8
pubmed: 27403309
Am J Gastroenterol. 1998 Jun;93(6):890-5
pubmed: 9647013
Gastrointest Endosc. 2019 Sep;90(3):415-423
pubmed: 31108093
Digestion. 2008;77(2):131-7
pubmed: 18391491
Gut. 1999 May;44(5):739-42
pubmed: 10205216
Gastroenterology. 2013 Jul;145(1):87-95
pubmed: 23542069
Gastroenterology. 1953 May;24(1):118-23
pubmed: 13052170
J Clin Gastroenterol. 1998 Jun;26(4):345-6
pubmed: 9649027
Endosc Int Open. 2014 Jun;2(2):E67-73
pubmed: 26135263
Am J Gastroenterol. 1990 Feb;85(2):138-44
pubmed: 2301336
Dig Endosc. 2012 Jul;24(4):237-42
pubmed: 22725108
J Clin Gastroenterol. 2004 Nov-Dec;38(10):898-900
pubmed: 15492609
Aliment Pharmacol Ther. 2008 Aug 15;28(4):412-21
pubmed: 18498445
J Gastrointest Surg. 2003 Jul-Aug;7(5):652-61
pubmed: 12850679
Endoscopy. 2014 Nov;46(11):963-9
pubmed: 25111135
Endoscopy. 2003 Dec;35(12):1024-8
pubmed: 14648415
J Rheumatol. 2010 Jul;37(7):1544
pubmed: 20595295
Endosc Int Open. 2015 Apr;3(2):E125-7
pubmed: 26135652
Gastrointest Endosc. 2008 Feb;67(2):324-7
pubmed: 18226696
Am J Gastroenterol. 1987 May;82(5):421-6
pubmed: 3578221
Gastrointest Endosc. 2013 Oct;78(4):584-8
pubmed: 23660565
J Am Coll Surg. 2003 Nov;197(5):864-7
pubmed: 14585429
Aliment Pharmacol Ther. 2006 Mar 15;23(6):691-712
pubmed: 16556171
Therap Adv Gastroenterol. 2009 Jan 1;2(3):149-156
pubmed: 20593010
Gastrointest Endosc. 2007 Jun;65(7):1090-2
pubmed: 17451706
Gastroenterology. 1989 Jul;97(1):207-12
pubmed: 2785944