Abstract
BackgroundGastric antral vascular ectasia (GAVE) is an uncommon but important cause of gastrointestinal bleeding in cirrhotic patients. Argon plasma coagulation (APC) is the standard therapy for GAVE. Endoscopic band ligation (EBL) is an emerging, safe and effective treatment for GAVE. The best way of applying EBL in the management of GAVE is not clear yet.AimWe aimed to determine the safety and efficacy of APC alternating with EBL versus EBL alone for managing GAVE in cirrhotic patients.Patients and methodsForty cirrhotic patients with bleeding GAVE were randomized to receive either APC alternating with EBL (20 patients) or EBL alone (20 patients) until GAVE lesions are eradicated. Gastroscopy was done 6 months after eradication of GAVE lesions to document recurrence. Cessation of bleeding, rise of hemoglobin level, need for transfusion, hospitalization, complications, number of sessions, and recurrence of GAVE in both groups were statistically analyzed.ResultsPatients in both groups showed significantly high rate of bleeding cessation, improvement in hemoglobin levels, reduction in transfusions, and hospitalizations. There was no statistically significant difference regarding the recurrence of GAVE between the two groups. There were no complications seen in the combined therapy group. Twenty percent of the patients in the EBL group had complications including hypertrophied polyp formation and post-band ulcerations.ConclusionAPC alternating with EBL and EBL alone are effective methods in the treatment of bleeding GAVE. Combined therapy has the potential to decrease the number of banding sessions and the number of rubber bands required to treat GAVE, consequently decreasing the incidence of band-related complications.
Highlights
Gastric antral vascular ectasia (GAVE) is an important cause of gastro-intestinal bleeding (GIB)
Patients and methods: Forty cirrhotic patients with bleeding GAVE were randomized to receive either Argon plasma coagulation (APC) alternating with Endoscopic band ligation (EBL) (20 patients) or EBL alone (20 patients) until GAVE lesions are eradicated
Twenty patients were randomized to group I who received APC alternating with EBL sessions, and the other twenty patients were randomized to group II who received EBL sessions (EBL group)
Summary
Gastric antral vascular ectasia (GAVE) is an important cause of gastro-intestinal bleeding (GIB). It is an uncommon cause of overt GIB but it is frequently associated with chronic blood loss and iron deficiency anemia [1]. GAVE is typically seen in distinct patient populations. Abdo et al Egyptian Liver Journal (2022) 12:8 It can occur in cirrhotic patients and cause non-variceal upper GIB. GAVE is seen in 3% of patients with advanced liver disease and 2% of those undergoing liver transplantation [3]. GAVE is considered to be responsible for 4% of non-variceal upper GIB in patients with and without portal hypertension [4]. Gastric antral vascular ectasia (GAVE) is an uncommon but important cause of gastrointestinal bleeding in cirrhotic patients. The best way of applying EBL in the management of GAVE is not clear yet
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