Nitrous oxide cryotherapy ablation for refractory gastric antral vascular ectasia

Abstract

Background: Argon plasma coagulation (APC) is typically the first-line therapy for gastric antral vascular ectasia (GAVE). However, many patients are refractory to APC ablation.

Objective: We examined the safety and efficacy of nitrous oxide CryoBalloon cryotherapy ablation for GAVE refractory to APC.

Methods: This is a retrospective review of patients with refractory GAVE treated with the CryoBalloon system. Technical success was defined as successful ablation of the visualized GAVE. Clinical success was defined by transfusion independence and percentage of GAVE that was eradicated.

Results: Twenty-three patients with GAVE were included, of whom 16 patients (70%) had two treatments with the CryoBalloon and seven patients (30%) had one treatment. Technical success was achieved in all patients. At six months, 19/23 (83%) were transfusion independent, while 20/23 (87%) had more than 75% of the GAVE eradicated. Patients were transfused an average of 1.8 units/month one year prior to cryotherapy and an average of 0.3 units/month up to six months post-cryotherapy (p < 0.001). The average increase in mean hemoglobin at six months was 2.55 g/dl. No acute or late adverse events were reported.

Conclusions: CryoBalloon ablation is an efficacious and safe modality for the treatment of GAVE. Prospective studies need to be conducted to determine comparative results to standard therapies.

Keywords: Ablation; cryotherapy; gastrointestinal bleeding; watermelon stomach.

Figures

Figure 1.

Nitrous oxide balloon cryotherapy system. (Image courtesy of C2 Therapeutics.)

Figure 2.

A patient with watermelon-type gastric antral vascular ectasia: (a) endoscopic view prior to treatment with CryoBalloon; (b) endoscopic image during CryoBalloon therapy; and (c) endoscopic image at three-month follow-up showing response to therapy.