Randomized controlled study of endoscopic band ligation and argon plasma coagulation in the treatment of gastric antral and fundal vascular ectasia

Abstract

Background: Gastric antral vascular ectasia (GAVE) is characterized by mucosal and submucosal vascular ectasia causing recurrent hemorrhage and thus, chronic anemia, in patients with cirrhosis. Treatment with argon plasma coagulation (APC) is an effective and safe method, but requires multiple sessions of endoscopic therapy. Endoscopic band ligation (EBL) was found to be a good alternative for APC as a treatment for GAVE, especially in refractory cases. The aim of this prospective randomized controlled study was to evaluate the safety and efficacy of EBL, as compared to APC, in the treatment of GAVE and gastric fundal vascular ectasia (GFVE). Patients and methods: A total of 88 cirrhotic patients with GAVE were prospectively randomized to endoscopic treatment with either EBL or APC, every 2 weeks until complete obliteration was accomplished; then they were followed up endoscopically after 6 months, plus they had monthly measurement of hemoglobin levels during that period. Results: We describe the presence of mucosal and submucosal lesions in the gastric fundal area that were similar to those found in GAVE in 13 patients (29.5%) of the EBL group and 9 patients (20.5%) of the APC group; we named this GFVE. In these cases, we treated the fundal lesions with the same techniques we had used for treating GAVE, according to the randomization. We found that EBL significantly decreased the number of sessions required for complete obliteration of the lesions (2.98 sessions compared to 3.48 sessions in the APC group (p < 0.05)). Hemoglobin levels increased significantly after obliteration of the lesions in both groups, compared to pretreatment values (p < 0.05), but with no significant difference between the two groups (p > 0.05); however, the EBL group of patients required a significantly smaller number of units of blood transfusion than the APC group of patients (p < 0.05). There were no significant differences in adverse events nor complications between the two groups (p > 0.05). Conclusions: This study described and histologically proved the presence of GFVE occurring comcomitantly with GAVE in cirrhotic patients. We showed that GFVE can be successfully managed by EBL or APC. Our study revealed that EBL is more effective and is comparable in safety to APC, in the treatment of GAVE and GFVE in cirrhotic patients.

Noninvasive clinical predictors of portal hypertensive gastropathy in patients with liver cirrhosis

“…Furthermore, gastric antral vascular ectasia (GAVE), which is characterized by stripes of red mucosa separated by normal mucosa, is considered a particular pattern of severe PHG (watermelon stomach), predominantly affects antrum. [2,3] The prevalence of PHG in patients with cirrhosis varies from 11% to 98%. According to Ahmed et al and Abbasi et al from Pakistan, its prevalence was around 80%.…”

Case series on multimodal endoscopic therapy for gastric antral vascular ectasia, a tertiary center experience

“…EBL has lately been demonstrated as a good alternative to APC especially in refractory cases of GAVE and has been found to have a similar safety profile and per Zepeda’s randomized controlled time performed better than APC[ 11 , 24 ].…”

“…Data is emerging on the resolution of GAVE following liver transplant in cirrhotics[ 9 ]. Endoscopic therapies have rapidly become the mainstays of first line therapy namely with argon plasma coagulation (APC) as the most common modality and more recently with radiofrequency ablation (RFA) using Halo 90 catheter[ 9 ] and endoscopic band ligation (EBL) both of which have been shown to be safe and effective for GAVE treatment[ 10 , 11 ]. The latter two have been utilized in treatment of severe, diffuse, APC refractory GAVE[ 10 , 21 ].…”

Image Diagnosis: Unusual Cause of Gastrointestinal Bleeding in a Young Man: Isolated Gastric Angiodysplasias

“…Although most endoscopists prefer APC for initial therapy of vascular lesions, a recent randomized trial conducted in patients with cirrhosis with gastric antral vascular ectasia suggested that the number of endoscopic sessions needed are reduced with use of endoscopic band ligation vis-àvis use of APC. 6 Comparative data on the use of band ligation and APC are lacking for other vascular lesions. Although distal gastrectomy is occasionally used for gastric antral vascular ectasia, gastrectomy for bleeding angiodysplasias is unusual because excellent effective endoscopic options are available.…”