Radiofrequency Ablation of Cameron Lesions

Excerpt

A 76-year-old woman was initially evaluated for weakness and recurrent melena accompanied by severe iron deficiency anemia. First diagnosed with iron deficiency anemia due to Cameron lesions 4 years prior to presentation, she was aggressively treated with oral and intravenous (IV) iron supplementation and omeprazole 40 mg twice daily. She had decided to forgo laparoscopic hernia repair and fundoplication fearful of potential perioperative complications. Her past medical history was otherwise significant for nonalcoholic steatohepatitis, hypertension, and bilateral pulmonary emboli that had resolved after the institution of IV heparin, IV tissue plasminogen activator, and oral warfarin therapy. Because she was heterozygous for a Leiden factor V mutation, an unfixed inferior vena cava filter had been placed. There was no history of aspirin or nonsteroidal anti-inflammatory drug (NSAID) use. On admission, she was pale, with hemoglobin of 8.1 mg/dl. An upper endoscopy demonstrated a large sliding hiatal hernia with several linear mucosal erosions at the level of the diaphragmatic hiatus without stigmata of recent hemorrhage (Fig. 1, left panel). Barium esophagram (Fig. 2, left panel) and computed tomography (CT) of the thorax (Fig. 2 middle and right panels) confirmed the large sliding hiatal hernia (HH). Because of the ongoing melena and anemia, she was treated with HALO^®-90 radiofrequency ablation (RFA) (Barrx™ RF Ablation, Covidien GI Solutions, Sunnyvale, CA) applied circumferentially at the level of the diaphragmatic pinch (Fig. 1, middle and right panels) which stabilized her clinically for >2 weeks, after which she underwent hernia repair and partial fundoplication.

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