S1421 Efficacy and Safety of Endoscopic Cryotherapy for the Management of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis

Introduction: Gastric antral vascular ectasia (GAVE) is often associated with chronic blood loss leading to iron deficiency anemia and frequent transfusion requirements. Argon plasma coagulation (APC) and endoscopic band ligation are treatment options. However, recurrence and treatment resistance are common, prompting the need for alternative strategies. Endoscopic cryotherapy, which involves the application of a cryogen to ablate GAVE, has shown promise in such refractory cases. Methods: We systematically searched MEDLINE, EMBASE, and Scopus from inception through May 2025 for studies evaluating endoscopic cryotherapy in GAVE. Primary outcomes were clinical response/success and technical success. A random-effects model was used for pooled estimates, and heterogeneity was assessed using the I² statistic. Results: Three studies involving 42 patients were included—2 prospective pilot studies and one retrospective cohort. Nitrous oxide cryogen was used in 2 studies and carbon dioxide in one. Of the included patients, 31 had prior APC treatment. The mean age of patients ranged from 63.6 to 71.7 with 76% women. The mean number of cryotherapy sessions per patient ranged from 1.7 to 3. Among 2 studies, the mean change in hemoglobin at study follow-up ranged from 1.3 to 2.6 g/d and mean number of blood transfusions per month after treatment ranged from 0.3 to 1.7. One cryotherapy related adverse event (self-limited abdominal pain) was observed across all 3 studies. The pooled clinical success rate was 70.1% (95% CI, 48.0–88.1%; I² = 49.8%). The pooled technical success rate was 97.1% (95% CI, 76.7–100%; I² = 87.6%). Conclusion: This meta-analysis demonstrates that endoscopic cryotherapy is an effective treatment option for GAVE, particularly in patients with incomplete response or recurrence after APC. Its high technical success and promising clinical outcomes support its use as a viable alternative in refractory cases. Larger, high-quality prospective studies are needed to validate these findings and to directly compare cryotherapy with other established treatment modalities to better inform clinical decision-making.