Treatment of Gastric Antral Vascular Ectasia (GAVE) with Endoscopic Band Ligation (EBL) after Failure of Endoscopic Thermal Therapy with Argon Plasma Coagulation (APC)

Abstract

Purpose: GAVE is a rare cause of gastrointestinal bleed leading to iron deficiency anemia with transfusion dependency. The first line of treatment is with APC. EBL has recently been used with success. We retrospectively reviewed 2 transfusion-dependent cirrhotic patients with GAVE, and compared the impact on transfusion requirements after treatment with APC and EBL. Methods: Medical records were reviewed and data collected include hematocrits, dates and units (U) of packed red blood cell (PRBC) transfusions, dates of APC and EBL. EBL technique was that used for esophageal variceal banding. Results: Patient 1 had 8 APC and 25 U PRBC over 4 months (6.25 U/month), followed by 3 monthly EBL. He also received another APC 7 months post initial EBL. Post EBL, he required 12 U PRBC over 9 months (1.33 U/month) which is a 78.7% drop in PRBC requirement. Patient 2 had 6 APC and 19U PRBC over 9 months (2.11 U/month). After 2 monthly EBL, he needed 1U PRB in 2 months (0.5 U/month). He then developed ascites, associated with a rise in PRBC requirement to 4 U/month despite 2 more EBL. Once his cirrhosis improved, he had not required any additional transfusions. Overall, since initial EBL, he required 11 U PRBC over 11 month (1 U/month) which was 52.3% drop in PRBC requirement. Conclusion: EBL can decrease PRBC requirement in cirrhotic GAVE patients who have failed APC. EBL may be more effective in controlling bleeding in compensated cirrhotics. This is consistent with the hypothesis that liver dysfunction plays a major role in the pathogenesis of GAVE associated with cirrhosis. We attribute the benefit of EBL to the occlusion of mucosal and submucosal vessels which is not achieved with APC.Figure: [661] Patient 1 transfusion requirement over time in relationship to his APC (red square) and EBL (green circle) treatments.Figure: [661] Patient 2 transfusion requirement over time in relationship to his APC (red square) and EBL (green circle) treatments.