Long-term follow-up in patients with gastric antral vascular ectasia (GAVE) after treatment with endoscopic band ligation (EBL)

Abstract

Background and study aims Gastric antral vascular ectasia (GAVE) is a capillary-type vascular malformation of the gastric antrum, usually diagnosed endoscopically in patients presenting with iron deficiency anemia or gastrointestinal bleeding. While there is established evidence for treatment with thermal modalities, such as argon plasma coagulation (APC) therapy, more recent studies have shown endoscopic band ligation (EBL) to be safe and effective in achieving remission. Our study aimed to evaluate long-term outcomes of patients with GAVE who underwent EBL at our institution. Patients and methods We retrospectively reviewed data from 33 patients with GAVE who underwent esophagogastroduodenoscopy and EBL between September 2012 and July 2017 within our institution, looking primarily at clinical response, recurrence, and blood transfusion requirements. Results Clinical response was achieved in 27 patients (81.8%). Among responders, recurrence-free survival decreased with time from 88 % at 1 year to 44 % at 2 years. Thirteen patients (48.1 %) had recurrence of GAVE at a mean time of 18.2 months (range 4.7 – 51.8). The only predictor of recurrence was greater number of pre-procedure blood transfusions. Conclusion This is the first study to evaluate long-term response and recurrence in patients with GAVE after treatment with EBL and predictors of clinical response after initial endoscopic therapy have been identified. While we were able to demonstrate excellent remission achievement rates in our GAVE patients who had undergone EBL, close clinical follow-up is clearly required as almost 50 % will have recurrence at around 18 months.

Is endoscopic band ligation the gold standard for gastric antral vascular ectasia?

“…Other previous reports, including a previous analysis performed by the same group, followed the same trend 17 18 . The current article published by Eccles et al 19 regarding long-term follow-up of patients with GAVE treated with EBL, further strengthens the case for expanding use of EBL in GAVE, with high initial success rate and relatively low recurrent bleeding rates, albeit in a small sample.…”

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

“…The durability of the response over a long period would be another potentially significant marker of efficacy, especially in light of a recent study reporting up to 44% recurrence of GAVE within 2 years of clinical response to therapy with EBL. 19 In conclusion, EBL appears to be both safe and effective in the management of GAVE-related blood loss. The limited literature suggests that compared to ETT, the use of EBL was associated with significantly lower transfusion requirements, and showed a trend towards more encouraging post-procedural Hb changes and lower number of procedures required to obliterate GAVE.…”

Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…It consists of mechanical strangulation of lesions through the placement of multiple elastic bands, resulting in thrombosis, necrosis, and subsequent fibrosis of the mucosa and submucosa. 22,23 Heater probes, Nd-YAG lasers, sclerotherapy, and cryotherapy have been largely replaced because of complications, lower success rates, and/or availability issues. 5,24 More recently, radiofrequency ablation (RFA) and hybrid-APC have emerged as alternative therapies.…”