Endoscopic band ligation versus argon plasma coagulation in management of bleeding from gastric antral vascular ectasia in patients with portal hypertension

Abstract

Background Gastric antral vascular ectasia (GAVE) may cause recurrent hemorrhage, and thus, chronic anemia, in patients with portal hypertension. Treatment with argon plasma coagulation (APC) is an effective and safe method in adults 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 study was to evaluate the safety and efficacy of EBL, as compared with APC, in treating nonvariceal upper GI bleeding GAVE in patients with portal hypertension. Patients and methods A total of 40 patients with bleeding from GAVE were prospectively randomized to endoscopic treatment with either EBL or APC, every 4 weeks, until complete obliteration was accomplished. Hemoglobin level was obtained before and after treatment; then they were followed up endoscopically after 6 months, with documentation of the recurrence of the lesion, if that occurred. Results We found that EBL significantly decreased the number of sessions required for complete obliteration of the lesions (1.85 ± 0.81 sessions compared with 4.15 ± 1.22 sessions in the APC group; P Conclusion We concluded that GAVE could be safely and successfully managed by EBL or APC. Our study revealed that EBL is more effective, more time saving, and is comparable in safety to APC, in treating nonvariceal upper GI bleeding GAVE in patients with portal hypertension.