Endoscopic treatment for gastric antral vascular ectasia

Abstract

Gastric antral vascular ectasia (GAVE) is one of the uncommon causes of upper gastrointestinal bleeding. Major treatment of GAVE includes pharmacotherapy, endoscopy, and surgery. The efficacy and safety of pharmacotherapy have not been sufficiently confirmed; and surgery is just considered when conservative treatment is ineffective. By comparison, endoscopy is a common treatment option for GAVE. This paper reviews the currently used endoscopic approaches for GAVE, mainly including argon plasma coagulation (APC), radiofrequency ablation (RFA), and endoscopic band ligation (EBL). It also summarizes their efficacy and procedure-related adverse events. The endoscopic success rate of APC is 40–100%; however, APC needs several treatment sessions, with a high recurrence rate of 10–78.9%. The endoscopic success rates of RFA and EBL are 90–100% and 77.8–100%, respectively; and their recurrence rates are 21.4–33.3% and 8.3–48.1%, respectively. Hyperplastic gastric polyps and sepsis are major adverse events of APC and RFA; and Mallory–Weiss syndrome is occasionally observed after APC. Adverse events of EBL are rare and mild, such as nausea, vomiting, esophageal or abdominal pain, and hyperplastic polyps. APC is often considered as the first-line choice of endoscopic treatment for GAVE. RFA and EBL have been increasingly used as alternatives in patients with refractory GAVE. A high recurrence of GAVE after endoscopic treatment should be fully recognized and cautiously managed by follow-up endoscopy. In future, a head-to-head comparison of different endoscopic approaches for GAVE is warranted.

A Case of Refractory Gastric Antral Vascular Ectasia Treated Successfully With Distal Gastrectomy and Billroth II Reconstruction

“…RFA is considered an alternative to APC, but to date, no randomized controlled trials have compared RFA to APC. RFA catheters are used to achieve adequate contact with tissue, and there are through-the-scope catheters with ablation areas of 1.2 cm2, 1.5 cm2, and 2.6 cm 2 , respectively: HALO 60 and HALO 90 [12]. Although the treatment success rate for RFA is reported to be up to 90%, persistent gastrointestinal bleeding can occur even after complete resection with the HALO 90 ablation system, and 13.3%-40% of GAVE patients remain in need of blood transfusion after RFA [12].…”

“…RFA catheters are used to achieve adequate contact with tissue, and there are through-the-scope catheters with ablation areas of 1.2 cm2, 1.5 cm2, and 2.6 cm 2 , respectively: HALO 60 and HALO 90 [12]. Although the treatment success rate for RFA is reported to be up to 90%, persistent gastrointestinal bleeding can occur even after complete resection with the HALO 90 ablation system, and 13.3%-40% of GAVE patients remain in need of blood transfusion after RFA [12]. Next, EBL has a treatment success rate of 77.8%-100%, but 15.4%-55.6% of GAVE patients require transfusion after EBL, with a recurrence rate of 8.3%-48.1% [13].…”

Gastric antral vascular ectasia (Watermelon stomach); an unusual cause of upper gastrointestinal bleeding in elderly: A case report

“…It can be asymptomatic or can cause occult and dominating upper gastrointestinal bleeding with hematemesis or melena. Despite blood transfusions and intravenous or oral iron supplements, many individuals present with refractory anemia [ 10 ].…”

Gastric Antral Vascular Ectasia (GAVE) a case report, review of the literature and update of techniques

“…Moreover, the endoscopic approach plays an insignificant role in PHG bleeding, where the only recommended treatments for reducing the bleeding are Transjugular intrahepatic portosystemic shunt ( TIPS ) or more aggressive surgical approaches (i.e. portosystemic shunt) [7] , [8] , [9] .…”