Study on the Efficacy of Endoscopic Radiofrequency Treatment in Reducing the Need for Blood Transfusions in GAVE

NCT ID: NCT06830317

Last Updated: 2025-02-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Total Enrollment

80 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-04-02

Study Completion Date

2027-09-02

Brief Summary

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The aim of the study therefore is to permanently resolve the existence of the bleeding sites caused by Gave and reduce both bleeding episodes and the need for transfusion in such patients applying "Barrx" (trademark) radiofrequency endoscopic ablation technology in selected cohort of patients that will be defined the patient inclusion section.

Detailed Description

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In the period from March 2025 to June 2027 n. 80 patients from 21 different medical Centers across Italy will be screened and their endoscopic findings will be shared centrally for the approval and confirmation of the GAVE diagnosis.

Formal written informed consent will take from patients to join the study. The study will be approved by our Ethics Committee of the promoting center (conforming to the 1975 Declaration of Helsinki).

Inclusion and exclusion criteria will be applied until the expected sample size is reached.

Following the GAVE diagnosis confirmation, all consecutive patients will be enrolled in the study and directed to the initial assessment before the treatment procedures. It is estimated that each center will aim to enroll n. 3-5 of pts in the participating centers over the next 24 months.

Treatment with Radiofrequency will carried out with focal Radiofrequency (RFA) with a through the scope (TTS) catheter at 12 J/cm2 to all visible areas of GAVE under conscious sedation or propofol sedation by experienced team of endoscopists and anesthetists. Prior to treatment, 2% N-acetylcysteine as a mucolytic will be applied.

All patients received pantoprazole (40 mg twice daily) and sucralfate (1 g three times per day) post-endoscopy for 4 weeks.

Following RFA procedures, all patients will return for a repeat endoscopy after 6 weeks for follow up post-treatment. In those for whom there will macroscopic GAVE present at this endoscopy, this will treated with Radiofrequency as at the initial therapy.

After 8 weeks following this, patients will return for a follow-up endoscopy during which images will captured of the gastric mucosa and will enter the follow-up phase during which Hb and ongoing transfusion/iron supplement will record at six and 12 months following the first procedure.

Conditions

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GAVE - Gastric Antral Vascular Ectasia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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cohort

Patients with existing diagnosis of GAVE (validated by an external expert)

Endoscopic Radiofrequency treatment

Intervention Type PROCEDURE

Treatment with RFA will carried out with focal RFA with a TTS catheter at 12 Joule/cm2 to all visible areas of GAVE under conscious sedation or propofol sedation by experienced team of endoscopists and anesthetists

QoL EQ5D questionaire

Intervention Type OTHER

Quality of Life EQ5D (by EuroQol Group) before every RFA treatment and at Follow up visits (3, 6 and 12 months after the first procedure). QoL questionnaire EQ5D The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The patient is asked to indicate his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions. This decision results in a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state

Interventions

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Endoscopic Radiofrequency treatment

Treatment with RFA will carried out with focal RFA with a TTS catheter at 12 Joule/cm2 to all visible areas of GAVE under conscious sedation or propofol sedation by experienced team of endoscopists and anesthetists

Intervention Type PROCEDURE

QoL EQ5D questionaire

Quality of Life EQ5D (by EuroQol Group) before every RFA treatment and at Follow up visits (3, 6 and 12 months after the first procedure). QoL questionnaire EQ5D The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The patient is asked to indicate his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions. This decision results in a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state

Intervention Type OTHER

Other Intervention Names

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RFA with a TTS catheter at 12 Joule/cm2

Eligibility Criteria

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Inclusion Criteria

* At least 18 years of age
* Existing diagnosis of GAVE (validated by an external expert)
* Melena and/or hematemesis secondary to GAVE and/or iron deficiency anemia persisting despite systemic iron therapy or oral supplementation and/or (concentrated red globules) GRC transfusions for at least 6 months
* Negative colonoscopy (performed within 12 months prior to enrollment, exclusion of any site of bleeding)
* Able to comply with study requirements and understand and sign the informed consent form

Exclusion Criteria

* Alternative causes for iron deficiency anemia (gastro-duodenal erosions and/or ulcerations, celiac disease, Inflammatory Bowel Disease (IBD), etc)
* Pregnancy
* Active malignancy (malignancy diagnosed in past five years or ongoing treatment)
* Anatomical malformations precluding treatment with RFA
* Blood coagulation deficit: International normalized ratio (INR)\>2, Platelets (PLT) \<50,000
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medtronic

INDUSTRY

Sponsor Role collaborator

Azienda Ospedaliera Specializzata in Gastroenterologia Saverio de Bellis

OTHER

Sponsor Role lead

Responsible Party

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Antonio Pisani

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Antonio Pisani, MD

Role: PRINCIPAL_INVESTIGATOR

National Institute of Gastroenterology Saverio De Bellis Research Hospital

Stefania Marangi, MD

Role: STUDY_CHAIR

National Institute of Gastroenterology Saverio De Bellis Research Hospital

Central Contacts

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Stefania Marangi, MD

Role: CONTACT

0804994233

Maurizio Polignano

Role: CONTACT

0804994365

References

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RIDER JA, KLOTZ AP, KIRSNER JB. Gastritis with veno-capillary ectasia as a source of massive gastric hemorrhage. Gastroenterology. 1953 May;24(1):118-23. No abstract available.

Reference Type BACKGROUND
PMID: 13052170 (View on PubMed)

Jabbari M, Cherry R, Lough JO, Daly DS, Kinnear DG, Goresky CA. Gastric antral vascular ectasia: the watermelon stomach. Gastroenterology. 1984 Nov;87(5):1165-70.

Reference Type BACKGROUND
PMID: 6332757 (View on PubMed)

Dulai GS, Jensen DM, Kovacs TO, Gralnek IM, Jutabha R. Endoscopic treatment outcomes in watermelon stomach patients with and without portal hypertension. Endoscopy. 2004 Jan;36(1):68-72. doi: 10.1055/s-2004-814112.

Reference Type BACKGROUND
PMID: 14722858 (View on PubMed)

Suit PF, Petras RE, Bauer TW, Petrini JL Jr. Gastric antral vascular ectasia. A histologic and morphometric study of "the watermelon stomach". Am J Surg Pathol. 1987 Oct;11(10):750-7.

Reference Type BACKGROUND
PMID: 3499091 (View on PubMed)

Shander A, Cappellini MD, Goodnough LT. Iron overload and toxicity: the hidden risk of multiple blood transfusions. Vox Sang. 2009 Oct;97(3):185-97. doi: 10.1111/j.1423-0410.2009.01207.x. Epub 2009 Aug 3.

Reference Type BACKGROUND
PMID: 19663936 (View on PubMed)

Fuccio L, Mussetto A, Laterza L, Eusebi LH, Bazzoli F. Diagnosis and management of gastric antral vascular ectasia. World J Gastrointest Endosc. 2013 Jan 16;5(1):6-13. doi: 10.4253/wjge.v5.i1.6.

Reference Type BACKGROUND
PMID: 23330048 (View on PubMed)

McCarty TR, Rustagi T. Comparative Effectiveness and Safety of Radiofrequency Ablation Versus Argon Plasma Coagulation for Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis. J Clin Gastroenterol. 2019 Sep;53(8):599-606. doi: 10.1097/MCG.0000000000001088.

Reference Type BACKGROUND
PMID: 29952856 (View on PubMed)

Patel A, Patel S, Wickremesinghe PC, Vadada D. Radiofrequency ablation using Barrx(R) for the endoscopic treatment of gastric antral vascular ectasia: a series of three cases and a review of the literature on treatment options. Clin Exp Gastroenterol. 2017 Jul 10;10:113-120. doi: 10.2147/CEG.S80241. eCollection 2017.

Reference Type BACKGROUND
PMID: 28744150 (View on PubMed)

Magee C, Lipman G, Alzoubaidi D, Everson M, Sweis R, Banks M, Graham D, Gordon C, Lovat L, Murray C, Haidry R. Radiofrequency ablation for patients with refractory symptomatic anaemia secondary to gastric antral vascular ectasia. United European Gastroenterol J. 2019 Mar;7(2):217-224. doi: 10.1177/2050640618814659. Epub 2018 Nov 15.

Reference Type BACKGROUND
PMID: 31080606 (View on PubMed)

Hayashi S, Saeki S. Endoscopic microvascular architecture of the portale hypertensive gastric mucosa on narrow band imaging. Dig Endosc 2007; 19: 116-123.

Reference Type BACKGROUND

Other Identifiers

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GAVE_STUDY

Identifier Type: -

Identifier Source: org_study_id

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