Guidance
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.
Description
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.
Coding recommendations
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
Z27.2 Stomach
In addition the ICD code K31.8 Other specified diseases of stomach and duodenum would be recorded.