SAFETY AND EFFICACY OF THE THULIUM AND ERBIUM LASER SYSTEM ON BLEEDING VASCULAR LESIONS OF THE GI TRACT: A REAL-LIFE MULTI-CENTRE STUDY

Aims:

Recent pilot studies assessed the feasibility of the Thulium and Erbium laser system (TELS) for endoscopic haemostasis, ablation and resection. Herein, we investigated for the first time ever, the safety and efficacy of endoscopic treatment with TELS in patients with gastrointestinal bleeding due to vascular lesions.

Methods:

Consecutive patients treated with TELS for chronic gastrointestinal bleeding with moderate/severe anaemia due to vascular lesions were enrolled in two Italian centres between March 2016 and October 2018.

Technical success and safety as established by the ASGE Lexicon, were defined as primary endpoints.

As secondary endpoints, we assessed the biological success comparing the lowest haemoglobin values ± 1 month prior to and after treatment, along with the need of packed red blood cells (PRB) transfusions ± 6 month prior to and after treatment. For gastric antral vascular ectasia (GAVE), a new scoring system was proposed to evaluate pre/post-treatment endoscopic severity by assessing both mucosal involvement (< 30%=+1, 30 – 50%=+2, > 50%=+3), and presence of bleeding (traces of blood =+3, active =+5). For each procedure, image/video documentations and TELS technical parameters (i.e., lasing time, power output, energy employed) were digitally recorded. Student paired t-test was performed.

Results:

Twenty-six patients (20 men; range 48 – 91 years) underwent 32 endoscopic TELS sessions for the treatment of angioectasias (14/26), GAVE (9/26), and RP (3/26). All procedures resulted in a complication-free technical success, thereby reaching the primary study endpoints. Haemoglobin values showed a significant rise along with a decreased need of PRB transfusions (Table 1). The median value of GAVE endoscopic severity remarkably improved within a six-month follow-up.

Conclusions:

This multicentre study conducted in real-life setting suggests that TELS is a safe and effective tool for the endoscopic treatment of patients with gastrointestinal bleeding caused by various types of superficial vascular lesions.