Gastric antral vascular ectasia in portal hypertensive children: Endoscopic band ligation versus argon plasma coagulation

Ghobrial, Carolyne; Rabea, Mohamed; Mohsen, Nabil; Eskander, Ayman

doi:10.1016/j.jpedsurg.2018.07.015

Cited by 8 publications

(26 citation statements)

References 14 publications

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“…GAVE has characteristic endoscopic appearances and can co-exist with PHG 50 51. The management of clinically significant bleeding from GAVE is challenging and options include medical therapies such as tranexamic acid, and endoscopic therapies such as argon plasma coagulation, band ligation and radiofrequency ablation 51–53. In refractory cases, surgical antrectomy can be considered in selected patients.…”

Section: Indications For Tipssmentioning

confidence: 99%

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Tripathi

Stanley

Hayes

et al. 2020

Gut

194

220

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These guidelines on transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the management of portal hypertension have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the Liver Section of the BSG. The guidelines are new and have been produced in collaboration with the British Society of Interventional Radiology (BSIR) and British Association of the Study of the Liver (BASL). The guidelines development group comprises elected members of the BSG Liver Section, representation from BASL, a nursing representative and two patient representatives. The quality of evidence and grading of recommendations was appraised using the GRADE system. These guidelines are aimed at healthcare professionals considering referring a patient for a TIPSS. They comprise the following subheadings: indications; patient selection; procedural details; complications; and research agenda. They are not designed to address: the management of the underlying liver disease; the role of TIPSS in children; or complex technical and procedural aspects of TIPSS.

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Section: Indications For Tipssmentioning

confidence: 99%

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Tripathi

Stanley

Hayes

et al. 2020

Gut

194

220

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“…While all studies concluded that EBL is safe and effective in the management of EBL, some studies mention its superiority over ETT in terms of lower transfusion requirements. In fact, in the pediatric population a randomized controlled trial (RCT) showed that, compared to ETT, EBL was associated with fewer sessions, shorter procedure times, less hospitalizations, and a lower rate of GAVE recurrence 12 …”

Section: Introductionmentioning

confidence: 99%

Endoscopic band ligation compared to thermal therapy for gastric antral vascular ectasia: A systematic review and meta‐analysis

Chalhoub¹,

Umar²,

Groudan³

et al. 2021

UEG Journal

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Background Gastric antral vascular ectasia is an infrequent cause of gastrointestinal-related blood loss manifesting as iron-deficiency anemia or overt gastrointestinal bleeding, and is associated with increased healthcare burdens. Endoscopic therapy of gastric antral vascular ectasia most commonly involves endoscopic thermal therapy. Endoscopic band ligation has been studied as an alternative therapy with promising results in gastric antral vascular ectasia. Aims The primary aim was to compare the efficacy of endoscopic band ligation and endoscopic thermal therapy by argon plasma coagulation for the management of bleeding gastric antral vascular ectasia in terms of the mean post-procedural transfusion requirements and the mean hemoglobin level change. Secondary outcomes included a comparison of the number of sessions needed for cessation of bleeding, the change in transfusion requirements, and the adverse events rate. Methods PubMed, Medline, SCOPUS, Google Scholar, and the Cochrane Controlled Trials Register were reviewed. Randomized controlled clinical trials and retrospective studies comparing endoscopic band ligation and endoscopic thermal therapy in bleeding gastric antral vascular ectasia, with a follow-up period of at least 6 months, were included. Statistical analysis was done using Review Manager. Results Our search yielded 516 papers. After removing duplicates and studies not fitting the criteria of selection, five studies including 207 patients were selected for analysis. Over a follow-up period of at least 6 months, patients treated with endoscopic band ligation had significantly lower post-procedural transfusion requirements (MD −2.10; 95% confidence interval (−2.42 − −1.77)) and a significantly higher change in the mean hemoglobin with endoscopic band ligation vs endoscopic thermal therapy (MD 0.92; 95% confidence interval (0.39 − 1.45)). Endoscopic band ligation led to a fewer number of required sessions (MD −1.15; 95% confidence interval (−2.30 − −0.01)) and a more pronounced change in transfusion requirements (MD −3.26; 95% confidence interval (−4.84 − −1.68)). There was no difference in adverse events. Conclusion Results should be interpreted cautiously due to the limited literature concerning the management of gastric antral vascular ectasia. Compared to endoscopic thermal therapy, endoscopic band ligation for the management of bleeding gastric antral vascular ectasia led to significantly lower transfusion requirements, showed a trend toward more remarkable post-procedural hemoglobin elevation, and a fewer number of procedures. Endoscopic band ligation may improve outcomes and lead to decreased healthcare burden and costs.

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“…More recently, the efficacy of EBL and APC in the treatment of GAVE was also assessed in a pediatric population. A prospective comparison confirmed the superiority of EBL in terms of the number of sessions required for the complete obliteration of the lesions (1.85 ± 0.81 vs 4.15 ± 1.22, P < 0.05), procedure time, transfusion requirement, hospitalization and recurrence rate of GAVE lesions 14 …”

Section: Discussionmentioning

confidence: 56%

“…Endoscopic band ligation (EBL) seems to be a comparable and promising alternative to APC (Figure 1B), and can be used to treat deep mucosal and submucosal lesions as well in a uniform manner; it may even be superior to APC in terms of the number of treatment sessions required 4,7,11‐13 . It is available in most centers and is considered a relatively easy procedure to perform 14,15 . Radiofrequency ablation, which also offers uniform ablation depth, achieves encouraging results as well, although further training is usually required so that physicians can be familiar with this technique 16,17 .…”

Section: Introductionmentioning

confidence: 99%

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

Fábián

Bor

Szabó

et al. 2020

J of Digest Diseases

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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.

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Gastric antral vascular ectasia in portal hypertensive children: Endoscopic band ligation versus argon plasma coagulation

Cited by 8 publications

References 14 publications

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension

Endoscopic band ligation compared to thermal therapy for gastric antral vascular ectasia: A systematic review and meta‐analysis

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

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