Endoscopic treatment of gastric antral vascular ectasia in real‐life settings: Argon plasma coagulation or endoscopic band ligation?

Abstract

ObjectiveThe efficacy of argon plasma coagulation (APC) on gastric antral vascular ectasia (GAVE) may be impaired over time and depends greatly on the application settings. Endoscopic band ligation (EBL) may be an alternative, but study on its efficacy is limited. This study aimed to evaluate and compare the clinical efficacy of APC and EBL in treating GAVE.MethodsChanges in the need for blood transfusion, number of treatment sessions and hospitalizations were retrospectively assessed in 63 transfusion‐dependent patients with GAVE (mean age: 67.1 y, 54.0% female) treated with either APC or EBL (45 and 18 patients, respectively) in four tertiary endoscopic centers.ResultsBoth methods substantially increased hemoglobin levels and decreased patients' need for a transfusion (22.0 ± 4.0 g/L and −5.62 ± 2.30 units of packed red blood cells [RBC] with APC, and 27.4 ± 6.1 g/L and −4.79 ± 2.46 units of packed RBC with EBL), without a significant statistical difference between the methods. However, fewer EBL sessions were required both for the cessation of need for a transfusion compared with those for the resolution of GAVE lesions (0.90 ± 0.10 vs 1.69 ± 0.31, P = 0.028).ConclusionsBoth APC and EBL are effective in GAVE treatment. EBL may be superior in terms of number of treatment sessions, but not in its influence on hemoglobin level and need for transfusion. Further prospective studies with large, homogeneous sample size and standardized APC settings are needed.

Endoscopic treatment for gastric antral vascular ectasia

“…The transfusion-dependent rate after APC is 9.1–50% 21 – 23 , 25 , 30 – 32 [ Figure 2(b) ]. The causes of transfusion after APC are often varied.…”

“…Hyperplastic gastric polyps 25 , 35 , 37 and fever 40 after APC have also been reported. Major adverse events are uncommon, including Mallory–Weiss syndrome, 32 scarring of ulcer, 22 , 32 and sepsis. 21 , 35 Probst et al 22 reported that one patient developed deep antrum ulcers followed by circumferential scarring of the antrum and asymptomatic stenosis 6 months after APC, and planned to undergo Billroth I surgery.…”

“…Transfusion requirement after EBL remained in 15.4%–55.6% of GAVE patients 32 , 69 [ Figure 4(b) ]. In a retrospective study, the indication of blood transfusion was defined as the amount of blood lost reached beyond 30% of the total blood volume in patients with acute hemorrhage, or if the hemoglobin concentration was less than 7 g/dl in patients with chronic hemorrhage.…”

“…The incidence of adverse events after EBL is 8.3–13.6% 32 , 38 , 40 , 68 , 69 [ Figure 4(d) ]. Common adverse events after EBL include nausea and vomiting 68 and mild esophagus or epigastric pain.…”

“…Some studies have demonstrated that EBL was significantly superior to ETT in hemostasis, 68 eradication of visible lesions on endoscopy, 28 treatment sessions, 32 , 68 , 72 improvement of hemoglobin, 72 transfusion requirement, 68 , 72 and recurrence. 38 In contrast, other studies found no difference between the two groups in terms of treatment sessions, 28 , 38 blood transfusion requirement, 32 improvement of hemoglobin, 28 , 32 , 68 and adverse events. 72 In a randomized controlled trial, 88 patients with GAVE were assigned to either the APC or EBL group.…”