Stomach - Cryotherapy of gastric antral vascular ectasia
Comments: This a demonstration of endoscopic cryotherapy in a patient with multiple gastric and duodenal arteriovenous malformations. This patient had been previously treated with bipolar cautery but bleeding was not successfully controlled. Cryotherapy refers to the application of extreme cold temperatures to induce a therapeutic effect. Cryotherapy can be used to treat mucosal vascular lesions such as radiation induced proctitis and arteriovenous malformations and watermelon stomach. Cryotherapy uses CO2 gas and when released through a catheter results in reduction in temperature by the Joule Thompson effect. Here you can see ice formation as a result of the cryo-spray. The spray technique allows rapid treatment of large areas of bleeding. Cryo-spray therapy results in a depth of injury of only 2-3mm in the GI mucosa. Therefore there is little concern if normal mucosa is affected by the cryospray.
In this patient, a duodenal AVM is being treated with cryospray therapy. The catheter is positioned 1-2 cm from the gastric mucosa. The cryospray is applied in a painting like maneuver to cover the areas affected by AVMs. The endpoint of therapy is the formation of ice on the mucosa. . Currently a drawback of cryospray therapy is temporary loss of visualization during the spray process due to formation of a mist. Throughout the process intermittent endoscopic suction should be applied in order to evacuate CO2 and reduction in the mist effect. The patient should be monitored for abdominal distention during the procedure. Cyrotherapy will result in necrosis of the treated superficial mucosa which will be followed by regeneration of normal mucosa in 7-10 days. Two days after the first session of cryospray therapy, there is superficial mucosal necrosis and elimination of vascular malformations. There is now loss of contact friability. At this point, cryospray therapy can be applied to the untreated areas where there are residual AVMs. You can see necrosis of the duodenal AVMs. These areas will regenerate into normal mucosa in 7-10days. The patient tolerated the procedure well and following this treatment, no longer required blood transfusions.
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Anthony Kalloo, M.D. Chief of Gastroenterology Johns Hopkins Medical Center |
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Citation: Kalloo, A. (Mar 09 2006). Stomach - Cryotherapy of gastric antral vascular ectasia. The DAVE Project. Retrieved Feb, 10, 2010, from http://daveproject.org/viewfilms.cfm?film_id=382 Times viewed since Feb 2006: 3851 |
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