Endoscopic mucosal ablation for the treatment of gastric antral vascular ectasia with the HALO⁹⁰ system: a pilot study

Background: Gastric antral vascular ectasia (GAVE) often results in GI bleeding and chronic anemia. Treatment options are limited and include medical, endoscopic, and surgical therapies. Objective: To assess the utility of endoscopic mucosal ablative therapy by using the HALO⁹⁰ system for patients with GAVE and recurrent bleeding. Design: Prospective open-label case series. Setting: Tertiary referral center. Patients: Six consecutive patients with GAVE, bleeding, and blood transfusion dependence. Main Outcome Measurements: Comparison of preablation and postablation Hb levels and transfusion requirements. To assess the number of ablation sessions needed to stabilize the Hb level and eliminate the need for blood transfusion. Results: Six patients, (4 men, mean age 58 years, range 47-65 years) underwent endoscopic mucosal ablation of antral lesions (mean procedure time 29 minutes; mean treatments 1.7, range 1-3). The mean Hb level improved from 8.6 to 10.2 g/dl (mean 2 months after the last ablation). Five of 6 patients are no longer dependent on blood transfusions to maintain a stable Hb level. Limitations: This is a pilot study, with a small number of patients at a single center, with limited patient follow-up. Conclusions: This study suggests that endoscopic mucosal ablation by using the HALO⁹⁰ system is a promising treatment option for chronic bleeding related to GAVE.