Gastric antral vascular ectasia (GAVE) is a rare but an important cause of gastrointestinal bleeding and anemia. Endoscopic ablation is usually successful, but treatment-refractory cases occur. We have used radiofrequency ablation (RFA) with the HALO90 device in these cases with positive results. Nine patients (5 female patients) with refractory GAVE were treated with RFA. Four had GAVE associated with cirrhosis, 4 had renal insufficiency, and 1 had both cirrhosis and renal insufficiency. Patients had received multiple endoscopic treatments before undergoing RFA over a period of up to 2 years (median 4; range, 2 to 15 y). A total of 2 to 6 (median 3) RFA sessions were performed until GAVE eradication. Endoscopic ablation was achievable in all patients. There were no complications of the treatments. Seven of the 9 patients had sustained response to RFA over a median follow-up of 11 months (range, 6 to 21 mo).