Radiofrequency ablation (RFA) for the treatment of refractory gastric antral vascular ectasia: a systematic review and meta-analysis

Abstract Purpose: Gastric antral vascular ectasia (GAVE) is an uncommon cause of upper GI bleeding characterized by mucosal and submucosal vascular ectasia that commonly manifests as occult bleeding and chronic anemia. Argon Plasma Coagulation (APC) is frequently used as initial treatment for symptomatic GAVE. APC often requires multiple endoscopies and patients may not have full resolution of symptoms. Radiofrequency ablation (RFA) has emerged as a successful alternative. This study aims to conduct a systematic review and meta-analysis to evaluate the safety and efficacy of RFA in the treatment of GAVE. Methods: A comprehensive search of Pubmed, EMBASE, and Web of Science databases was performed, which focused on reviewing titles/abstracts, choosing relevant studies, and conducting necessary data extrapolation. This search was done on literature from 2008 up until June 2018 and studies with less than 5 patients were excluded. The measured parameters included improved hemoglobin levels, transfusion dependence, RFA treatment modality, adverse events, and number of RFA treatments. Results: We identified a total of 8 studies (N=128 patients) that used RFA for refractory GAVE. The HALO-90 or HALO-ULTRA ablation catheter (Covidien, GI Solutions, Sunnyvale, CA, USA), with a power capacity of 10-15 J/cm2, were the treatment modalities used. The overall clinical success rate for RFA in treatment for refractory GAVE was 68% (59%-76%, I2 value for heterogeneity 0). Average pre-treatment Hb value increased significantly from 8.03 (6.88-9.18, I2 94) to 10.38 (9.49-11.27, I2 77) after the RFA treatment. This difference was statistically significant: Standardize difference in mean 1.92 (0.50-3.35, p Conclusions: RFA can be an effective alternative in treatment for GAVE refractory to APC. While long-term data is limited, the evidence shows improved Hemoglobin levels and decreased transfusion dependence in treated patients. Further controlled trials are needed to compare the long-term safety, efficacy, and cost-effectiveness between RFA and APC in the treatment of GAVE and CRP.