Radiofrequency ablation may be more effective tolerable treatment for GAVE than APC

WASHINGTON — Radiofrequency ablation has emerged as possibly being a more effective and tolerable option compared to argon plasma coagulation in the treatment of gastric antral vascular ectasia according to findings from Yale University presented at Digestive Disease Week.

While not a common cause of intestinal bleeding, gastric antral vascular ectasia (GAVE) can result in iron deficiency anemia and frequent transfusion therapy, according to study background. Argon plasma coagulation (APC) is the standard treatment for GAVE, but some researchers believe radiofrequency ablation (RFA) is more effective, despite a lack of data comparing the two endoscopic modalities.

Tarun Rustagi, MD, a gastroenterology fellow in the section of digestive diseases at Yale University School of Medicine, and Thomas McCarty, MD, a resident in the department of internal medicine at Yale University School of Medicine, conducted a study to perform a systematic review and meta-analysis of all eligible studies to compare the efficacy of RFA to that of APC in the treatment of GAVE.

Rustagi and McCarty conducted an independent review of the MEDLINE and Embase databases through November, 2014, to compare the treatments.

They found 28 studies that met their inclusion criteria. From that group there were six on RFA with a total of 72 patients and 22 on APC with a total of 469 patients. There were no studies that directly compared RFA to APC in treatment of GAVE. The overall mean follow-up for the RFA studies was 6.35 months compared with 18.15 months for APC.

Of the patients in the RFA studies, 57% of the patients enrolled had failed prior APC treatment. Pre-treatment hemoglobin levels (weighted mean, 7.65 gm% vs. 7.96 gm%) as well as the hemoglobin levels post-treatment (2.51 gm%, [a change of 32.8%] vs. 2.58 gm% [a change of 32.4%]) were comparable between RFA and APC respectively.

The proportion of patients who became transfusion-free at the end of therapy was 79.2% in the RFA group and 87.3% in the APC group, however, the reported clinical success for RFA (88.5%) was significantly higher compared to APC (61.4%; P < .001).

Additionally, RFA required fewer endoscopic treatment sessions (mean, 1.99) than APC (mean, 3.26). RFA was also more tolerable, as it had less-severe and fewer complications (2.8%) than APC (6.9%). APC had one case of antral stenosis, eight cases of ulcer-related bleeding and one patient requiring antrectomy, which resulted in death. Meanwhile, the only adverse event for RFA was one bleeding ulcer.

“RFA may be more cost-effective as a therapeutic option for the treatment of GAVE,” Rustagi said in his presentation. “And evidence suggests it is more effective and tolerable than APC. However, future controlled trials are needed to confirm these findings and to directly compare these treatments for their efficacy, safety and long-term durability.” – by Anthony SanFilippo

For more information: Rustagi, T, et al. Abstract 213. Presented at: Digestive Disease Week; May 15-19, 2015; Washington.

Disclosure: Rustagi reports no relevant financial disclosures. See the faculty disclosure index on the DDW website for a full list of disclosures.