Introduction Gastric Antral Vascular Ectasia (GAVE) and radiation proctitis can cause chronic GI bleeding and may be severe enough to cause transfusion dependent anaemia.
Current standard therapy for both these conditions is endoscopy with argon plasma coagulation. This usually requires multiple endoscopies over time and in many patients may be ineffective.
With the development of Radiofrequency Ablation (RFA) in Barrett’s Oesophagus, we extended its use in these two settings. The available literature is small and our study adds to this body of evidence.
Methods Retrospective case record study. We collected data from all patients who received RFA between December 2012 and November 2013. Data was collected from endoscopy reports and electronic case records.
RFA was performed using the Halo 60,90 or through the scope probes at 12j energy (Barxx/Covidien).
Results Three patients received RFA for GAVE and six patients for Radiation proctitis.
GAVE: All patients presented with transfusion dependent anaemia. They needed 0.85 OGD/pt/month, 0.41 APC/pt/month and 6 units of packed cells /pt/month prior to RFA. Between 2–4 sessions of RFA was required. Post RFA, there was a reduction in endoscopies to 0.34/pt/month (P 0.239) In two out of three patients no further transfusions were required. Hence there was a significant reduction in transfusion requirement. (P 0.033).
Radiation Proctitis: All patients presented with PR bleeding. One was transfusion dependent. A mean of 0.58 APC sessions were done per patient/month. There was a significant reduction in the number of sigmoidoscopies from 0.87/pt/month to 0.2/pt/month (P 0.007). One patient who was requiring 9 units of packed cells per month stopped transfusions after RFA. Number of RFA sessions was between 1–3 (mean: 1.66).
In the NHS, therapeutic sigmoidoscopy with APC costs £704 and therapeutic OGD is £667. A single unit of blood transfusion costs £635. An RFA probe costs £920 and hence an RFA procedure proves cost effective above 2x APC or 2x blood transfusions.
Our only complication was one clinically insignificant stricturing but this was after 8xAPC and 3X RFA. Healing is optimum after 3 months. It is better tolerated than APC in terms of comfort.
Conclusion RFA for GAVE and RP is technically feasible, well tolerated and cost effective. We have demonstrated that there was a significant reduction in blood transfusions in GAVE and requirement for Sigmoidoscopy in RP.
We have shown no significant complications and RFA should be considered as a first line treatment in refractory GAVE and in RP where bleeding is significant.
We recognise this is a small, retrospective study but future work will include larger numbers, QoL data and establish if this should be considered the first line therapy.
Disclosure of Interest None Declared.
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