Impact of Cryotherapy Spray (Tru-Freeze) for the Eradication of Gastric Antral Vascular Ectasia (ICE-GAVE)

Inclusion Criteria • Diagnosis of antral-predominant GAVE: Endoscopic confirmation of gastric-antral vascular ectasia affecting the antrum, without severe portal-hypertensive gastropathy. Sub-classify as nodular or non-nodular GAVE. * Age: ≥ 18 years at the time of consent. * Recent transfusion-dependent anemia * ≥ 1 packed-RBC transfusion for GAVE-related bleeding within the last 6 months to maintain hemoglobin (Hgb) \> 8 g/dL (or \> 7 g/dL if no coronary/vascular disease). * Standard-of-care transfusion thresholds: * If no coronary artery/vascular disease (CVD): transfuse 2 units when Hgb \< 7 g/dL. * If CVD present: transfuse 2 units when Hgb \< 8 g/dL. * After any transfusion, re-check Hgb within 1 week and repeat transfusion per the same criteria as needed. * Documented transfusion history: o Medical records must show indication that each transfusion was for presumed GAVE-related bleeding. * Treatment status: o Either treatment-naïve or ≤ 3 prior endoscopic ablation sessions for GAVE. * Baseline data availability: Participant records must include endoscopic treatment dates, hemoglobin values, and transfusion data for 6 months prior to enrollment (extension up to 9 months permitted if data unavailable). Required elements: * total number of transfusions, * total number of prior endoscopic treatments, and calculated change in hemoglobin from baseline: Δ Hgb = Hgb(T-6 mo) - Hgb(T0) \[extendable to Hgb(T-9 mo) if 6-month data are incomplete\] * Capacity to consent: Able and willing to provide written informed consent. Exclusion Criteria * Other gastrointestinal pathology o Active peptic-ulcer disease, inflammatory bowel disease, severe portal-hypertensive gastropathy, or untreated esophageal/gastric varices. * Coagulopathy o Known bleeding disorder or acquired coagulopathy not attributable to GAVE. * Severe comorbidity / high procedural risk * Advanced heart failure, severe renal impairment, or any condition classified ASA IV or V. * Estimated life-expectancy \< 6 months. * Karnofsky performance status ≤ 40. * Deemed unfit for endoscopic procedures by the treating physician. * Pregnancy / lactation: o Pregnant or breastfeeding, or planning pregnancy within 6 months of consent. * Prior incompatible therapy o Previous cryoballoon ablation for GAVE. * Ability to participate * Unable or unwilling to comply with the protocol or follow-up schedule. * Unable or unwilling to provide written informed consent.