SAFETY AND EFFICACY OF HYBRID-APC FOR THE TREATMENT OF REFRACTORY GAVE

We present the case of a 62 years-old female refered to our hospital because of melena and iron deficiency anemia. Her past medical history included type 2 Diabetes and arterial hypertension in good control. She begun her complaint in 2013 with diagnosis of Gastric Antral Vascular Ectasia and received endoscopic treatment since then with argon plasma coagulation, with partial response. In 4 years she had requiered 12 hospitalizations and 38 transfusions combined with iron IV applications. However, and because of being a refractory case the new hybrid-APC management was offered.

This technique consist in three different steps: First the creation of a submucosal bleb below the GAVE lesions. Second: The application of high voltage APC current (100w, flow = 2 l/min) and ablate of lesions in the gastric antrum. Finally, to make a curretage with an straight cap of the debris obtained and repeat again the bleb creation and ablation steps.

After signing of informed consent patient hybrid APC was done in this patient.

In the video we can observe the presence of GAVE wattermellon type. We are performing ablation technique firstly with creation of a bleb with a combined solution of metilene blue at 0.5% with water. Then ablation of the lesions, curettage and new ablation without cap. Endoscopic ablation is observed. Total procedure time was 48 minutes.

Patient was discharged 12hrs after procedure. She presented mild abdominal pain well controlled with analgesics. At follow-up, complete endoscopic ablation was confirmed combined with an increase in Hb levels from 6.1gr/dl to 14.4 g/dl at 6 months after ablation. no more transfusions, iron IV or hospitalizations were required

Conclusions:

Hybrid-APC represents a new safe alternative to patients with refractory GAVE to other conventional treatments showing adecuate efficacy at mid-term evaluation. However, more studies are needed in order to determine long-term efficacy of this new procedure.