The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Radiofrequency ablation for gastric antral vascular ectasia, in June 2015.
Gastric antral vascular ectasia (GAVE) syndrome, also known as 'watermelon stomach', is a rare but well-recognised cause of chronic upper gastrointestinal blood loss. It is more common in older people. It may lead to iron-deficiency anaemia and transfusion dependence. Rarely, it can cause acute haemorrhage. GAVE is associated with heterogeneous medical conditions, including hepatic, renal, cardiac and autoimmune diseases, but its pathogenesis is unknown. GAVE is characterised endoscopically by diffuse or linear red patches or spots in the antrum of the stomach, which can give a 'watermelon' type of appearance. The classic histopathological findings are vascular ectasia of mucosal capillaries, focal thrombosis, spindle cell proliferation and fibrohyalinosis.
Initial treatment for GAVE includes endoscopic thermoablation techniques (such as argon plasma coagulation, laser photoablation, cryotherapy) and band ligation. Some patients continue to need blood transfusions despite repeat endoscopic treatments. When endoscopic therapy is not successful, antrectomy may be considered. Surgical resection of the affected part of the stomach is curative, but is associated with risks of morbidity and mortality.
The OPCS-4 codes for Radiofrequency ablation for gastric antral vascular ectasia are:
G43.5 Fibreoptic endoscopic destruction of lesion of upper gastrointestinal tract NEC
Y13.4 Radiofrequency controlled thermal destruction of lesion of organ NOC
Includes: Radiofrequency ablation of lesion of organ NOC
In addition the ICD code K31.8 Other specified diseases of stomach and duodenum would be recorded.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
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Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
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