• Chronic kidney disease
• Gastrointestinal angiectasias
• Gastrointestinal bleeding

• Humans
• Male
• Female
• Case-Control Studies
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/epidemiology
• Aged
• Middle Aged
• Risk Factors
• Retrospective Studies
• Gastrointestinal Diseases/epidemiology
• Gastrointestinal Diseases/complications
• Gastrointestinal Diseases/etiology

• Endocrinology
• Surgical procedure

• Humans
• Cryosurgery/methods
• Endoscopy, Gastrointestinal/methods
• Barrett Esophagus/surgery
• Barrett Esophagus/therapy
• Cryotherapy/methods
• Esophageal Neoplasms/surgery
• Esophageal Neoplasms/therapy
• Treatment Outcome
• Gastrointestinal Hemorrhage/therapy
• Gastrointestinal Hemorrhage/etiology
• Esophageal Stenosis/therapy
• Esophageal Stenosis/surgery
• Esophageal Stenosis/etiology

• Endoscopic management
• Gastrointestinal bleeding
• Iron deficiency anemia
• Liver cirrhosis
• Portal hypertension

• Humans
• Gastric Antral Vascular Ectasia/complications
• Gastric Antral Vascular Ectasia/diagnosis
• Gastric Antral Vascular Ectasia/therapy
• Stomach Diseases/complications
• Stomach Diseases/diagnosis
• Hypertension, Portal/complications
• Endoscopy, Gastrointestinal/adverse effects
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy

• Guidelines
• Quality evaluation
• Radiation enteritis
• Treatment

• Barrett’s esophagus
• Cryotherapy
• Esophageal cancer
• Gastric antral vascular ectasia
• Palliative therapy

• argon plasma coagulation
• polidocanol sclerotherapy
• radiation-induced hemorrhagic gastritis

• Adult
• Argon Plasma Coagulation
• Carcinoma, Hepatocellular/radiotherapy
• Endoscopy, Digestive System
• Gastritis/diagnostic imaging
• Gastritis/etiology
• Gastritis/therapy
• Gastrointestinal Hemorrhage/diagnostic imaging
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Liver Neoplasms/radiotherapy
• Male
• Neoplasm Recurrence, Local/radiotherapy
• Radiation Injuries/diagnostic imaging
• Radiation Injuries/therapy
• Sclerotherapy

• Ablation
• cryotherapy
• gastrointestinal bleeding
• watermelon stomach

To study and describe patients who underwent treatment for gastric antral vascular ectasia (GAVE) with different endoscopic treatment modalities.

We reviewed patients with GAVE who underwent treatment at University of Alabama at Birmingham between March 1, 2012 and December 31, 2016. Included patients had an endoscopic diagnosis of GAVE with associated upper gastrointestinal bleeding or iron deficiency anemia.

Seven out of 15 patients had classic watermelon description for GAVE, 1/15 with diffuse/honeycomb pattern and 6/15 with nodular GAVE per EGD description. Seven out of 15 patients required multimodal treatment. Four out of six of patients with endoscopically nodular GAVE required multimodal therapy. Overall, mean pre- and post-treatment hemoglobin (Hb) values were 8.2 ± 0.8 g/dL and 9.7 ± 1.6 g/dL, respectively (P ≤ 0.05). Mean number of packed red blood cells transfusions before and after treatment was 3.8 ± 4.3 and 1.2 ± 1.7 (P ≤ 0.05), respectively.

Patients with nodular variant GAVE required multimodal approach more frequently than non-nodular variants. Patients responded well to multimodal therapy and saw decrease in transfusion rates and increase in Hb concentrations. Our findings suggest a multimodal approach may be beneficial in nodular variant GAVE.

• Gastric antral vascular ectasia
• Upper GI bleed
• Radiofrequency ablation
• Endoscopic band ligation
• Argon plasma coagulation

• antrectomy
• endoscopic hemostasis
• gastric antral vascular ectasia
• gastrointestinal bleeding

• Barrett’s esophagus
• Cryoablation
• Endoscopic cryotherapy
• Esophageal cancer
• Esophageal neoplasia

• APC, argon plasma coagulation
• ASGE, American Society for Gastrointestinal Endoscopy
• HGD, high-grade dysplasia
• RFA, radiofrequency ablation

• AVM, arteriovenous malformation
• BE, Barrett’s esophagus
• CE-D, complete elimination of dysplasia
• CE-IM, complete elimination of intestinal metaplasia
• CPT, Current Procedural Terminology
• GAVE, gastric antral vascular ectasia
• HGD, high-grade dysplasia
• RFA, radiofrequency ablation
• RP, radiation proctopathy
• RVU, relative value unit

We report a unique case of a 79-year-old woman with metastatic rectal cancer who developed bowel obstruction following endoscopic cryotherapy with liquid nitrogen for palliation of bleeding in the rectum. She developed abdominal distention and pain following the procedure. Computed tomography of the abdomen revealed a paraumbilical hernia containing a segment of transverse colon resulting in partial bowel obstruction. It appears that the recurrent freeze-thaw cycles with poor decompression of the colon despite active venting suction during cryotherapy may have resulted in bowel distention and collapse, causing conformational changes resulting in partial bowel obstruction due to a paraumbilical hernia.

• Endoscopy
• Gastric antral vascular ectasia
• Gastrointestinal bleeding
• Stomach

• Argon plasma coagulation
• Bipolar probe
• Cryotherapy
• Endoscopic treatment
• Formalin
• Laser
• Pelvic radiotherapy
• Proctitis
• Radiation proctopathy
• Radiofrequency ablation

• Cryotherapy
• Endoscopic suturing
• Endoscopic ultrasound
• Gastrointestinal bleeding
• Hemostasis
• Over-the-scope clip
• Radiofrequency ablation

• Argon Plasma Coagulation/methods
• Gastrointestinal Hemorrhage/surgery
• Hemostasis, Endoscopic/methods
• Humans

AIM: To assess the feasibility and safety of liquid nitrogen spray cryoablation at the duodenal papilla in a porcine model.

METHODS: This prospective study protocol was approved by the University of Florida Institutional Animal Care and Use Committee. Six pigs underwent liquid nitrogen spray cryotherapy at the duodenal papilla. Freeze time of 20-s was applied per cycle (4 cycles/session). Survival animals (n = 4) were monitored for adverse events. Hemoglobin, white blood count, liver tests, and lipase were obtained at baseline and post-treatment. EGD was performed on day#7 to evaluate the papilla and for histology. All animals were euthanized and necropsy was performed at the end of the one-week survival period. Feasibility was defined as successful placement of the decompression tube in the duodenum, followed by delivery of spray cryotherapy to the duodenal papilla. Safety was determined by monitoring post-treatment blood tests and clinical course. Treatment effect was defined as endoscopic and histologic changes after cryotherapy. This was established by comparing endoscopic and histologic findings from mucosal biopsies prior to cryotherapy and on post-operative day (POD)#7. Full-thickness specimen was obtained post-mortem to assess depth of injury.

RESULTS: Spray cryotherapy was feasible and successfully performed in all 6/6 (100%) animals. Cryospray with liquid nitrogen (four 20-s freeze-thaw cycles) at the duodenal papilla resulted in white frost formation at and around the target region. The mean procedural time was 54.5 min (range 50-58 min). All six animals studied had stable blood pressure, heart rate, and pulse oximetry measurements during the procedure. There were no significant intra-procedural adverse events. There were no significant differences in hemoglobin, white cell count, liver tests or lipase from baseline to post-cryotherapy. Survival animals were monitored daily post-operatively without any clinical ill effects from the cryotherapy. There was no bleeding, infection, or perforation on necropsy. Endoscopic on POD#7 showed edema and ulceration at the duodenal papilla. On histology, there was loss of crypt architecture with moderate to severe necrosis and acute mixed inflammatory infiltration in each specimen following cryotherapy. The extent of cryogen-induced tissue necrosis (depth of injury) was limited to the mucosa on full-thickness specimen evaluation.

CONCLUSION: Endoscopic liquid nitrogen spray cryotherapy is feasible and safe for ablation at the duodenal papilla in a porcine model.

• Liquid-nitrogen cryotherapy
• Cryoablation
• Duodenal adenoma
• Ampullectomy
• Papillectomy

• Clips
• Endoscopic band ligation
• Gastrointestinal bleeding
• Hemostasis
• Hemostatic spray
• Peptic ulcer bleeding
• Perforation
• Thermal coagulation

• Low-dose-rate brachytherapy
• Prostate cancer
• Radiation proctitis
• Rectal bleeding
• Rectal toxicity

Radiation proctopathy is a complication of pelvic radiotherapy, which occurs in patients treated for carcinoma of the prostate, rectum, urinary bladder, cervix, uterus, and testes. If it presents within 6 weeks to 9 months after therapy, it is called acute radiation proctitis/proctopathy (ARP), and if it occurs 9 months to a year after treatment, it is classified as chronic radiation proctitis/proctopathy (CRP). CRP occurs in 5%–20% of patients receiving pelvic radiation, depending on the radiation dose and the presence or absence of chemotherapy. In many cases, CRP resolves spontaneously, but in some, it can lead to persistent rectal bleeding. Other symptoms of CRP include diarrhea, mucoid discharge, urgency, tenesmus, rectal pain, and fecal incontinence. Despite the availability of several therapies, many patients fail to respond, and continue to suffer in their quality of life. Radiofrequency ablation (RFA) is a newer endoscopic technique that uses radiofrequency energy to ablate tissue. This is an emerging way to treat radiation proctopathy and other mucosal telangiectasia. We present three cases of radiation proctopathy treated with RFA at our institute and review the literature on treatment modalities for CRP. We were also able to find 16 other cases of CRP that used RFA, and review their literature as well as literature on other treatment modalities.

• BarRx
• Halo catheter
• radiation proctopathy
• radiofrequency ablation

• Cryotherapy
• EUS-guided angiotherapy
• Endoscopic suturing
• Hemostasis
• Hemostatic spray
• Nonvariceal upper gastrointestinal bleeding
• Over-the-scope clip
• Radiofrequency ablation

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in life-threatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.

• Bronchi
• Bronchoscopy
• Cryotherapy
• Hemorrhage

• Angiodysplasia
• Comparison Analysis
• Gastric Antral Vascular Ectasia
• Systematic Review

• Argon plasma coagulation
• Endoscopic laser therapy
• Formalin
• Hyperbaric oxygen
• Radiation colitis
• Radiation proctitis
• Short-chain fatty acids
• Sucralfate

• Radiation proctitis
• gastrointestinal bleeding
• proctopathy
• radiofrequency ablation

Cryotherapy is the therapeutic application for tissue ablation. Clinical applications of cryotherpy such as in pulmonology have increased. Until now, its development in gastroenterology has been insignificant. But, as clinical application such as mucosal ablation on Barrett's esophagus became possible, various applications have been developed. Therefore, it is important to make standards of tissue injury's extent in cryotherapy prior to clinical trial. We evaluated the tissue injury according to the application of cryoprobe with a pig model.

Cryoprobe was applied to several different segments of the esophagus and stomach for various lengths of time using various number of probe's contact in a pig model. After 48 hours, esophagus and stomach were harvested and histological tissue injury was assessed. The extent of tissue injury was decided by the injury of the deepest layer.

Endoscopic application of cryoprobe on esophagus and stomach resulted in a dose-dependent injury: esophageal necrosis was limited to the submucosa after 10 seconds of cryotherapy, and extended to involve the transmural necrosis after over 15 seconds. Necrosis on stomach was extended to involve the transmural necrosis after over 20 seconds.

Positive relationship was seen between the duration and frequency of cryoprobe application and the extent of tissue injury.

• Cryotherapy
• Tissue injury

Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously, some lead to chronic symptoms including diarrhea, tenesmus, urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insufficient. There are very few controlled or prospective trials, and comparisons between therapies are limited because of different evaluation methods. Medical treatments, including formalin, topical sucralfate, 5-amino salicylic acid enemas, and short chain fatty acids have been used with limited success. Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe, neodymium:yttrium-aluminium-garnet laser, potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benefit, but with frequent complications. Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its efficacy and safety profile. Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application, with lower rate of complications. This review will focus on endoscopic ablation therapies, including such newer modalities, for chronic radiation proctitis.

• Chronic
• Radiation proctitis
• Endoscopic
• Argon plasma coagulation
• Radiofrequency
• Cryoablation

• Argon Plasma Coagulation
• Diagnosis, Differential
• Gastric Antral Vascular Ectasia/diagnosis
• Gastric Antral Vascular Ectasia/etiology
• Gastric Antral Vascular Ectasia/physiopathology
• Gastric Antral Vascular Ectasia/surgery
• Gastrointestinal Hemorrhage/drug therapy
• Gastrointestinal Hemorrhage/etiology
• Humans
• Hypertension, Portal/complications
• Hypertension, Portal/drug therapy
• Hypertension, Portal/etiology
• Liver Cirrhosis/complications
• Stomach Diseases/diagnosis
• Stomach Diseases/drug therapy
• Stomach Diseases/etiology
• Stomach Diseases/physiopathology

• P30 DK34989 NIDDK NIH HHS

• Chronic Disease
• Colonoscopy/methods
• Cryosurgery/methods
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Pelvic Neoplasms/radiotherapy
• Pilot Projects
• Proctitis/etiology
• Proctitis/surgery
• Prospective Studies
• Radiation Injuries/complications
• Radiation Injuries/surgery
• Treatment Outcome