Tu1485 ENDOSCOPIC BAND LIGATION COMPARED TO THERMAL THERAPY FOR GASTRIC ANTRAL VASCULAR ECTASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Gastric antral vascular ectasia (GAVE) is an infrequent cause of gastrointestinal-related blood loss and is associated with portal hypertension and cirrhosis. Bleeding from GAVE is associated with increased healthcare burdens as it entails multiple endoscopies, hospitalizations, and blood transfusions. Endoscopic therapy remains the mainstay of treatment and most commonly involves endoscopic thermal therapy (ETT) with argon plasma coagulation (APC) or heat probe. Endoscopic band ligation (EBL) has been studied as an alternative therapy with promising results. The primary aim was to compare the efficacy of EBL and ETT in terms of the average number of post-procedural mean transfusion requirements and mean hemoglobin change. The secondary aim was to compare the number of sessions needed for cessation of bleeding from GAVE. PubMed, Medline, SCOPUS, and Cochrane Controlled Trials Register were reviewed. Randomized controlled trials and retrospective studies comparing EBL and ETT in bleeding GAVE with a follow up period of at least 6 months were included. OpenMetaAnalyst was used for the statistical analysis, which was performed using the random-effects model, and mean difference (MD) with 95% confidence intervals (CI) were evaluated for the quantitative analyses of all outcomes. Our database search yielded a total of 516 papers. After removing duplicates, excluding papers published in languages other than English, and removing pediatric studies and those not looking at our outcomes of interest, 5 studies were selected for analysis (1–5). Of the selected studies, 3 were retrospective and 2 were randomized control trials. The pooled number of included patients was 207. EBL was performed in 93 patients and ETT was performed in 114 patients. Our meta-analysis showed that over a follow-up period of at least 6 months, patients treated with EBL had significantly lower post-procedural transfusion requirements compared to the those in ETT group with a mean difference of 2 transfusions [MD -2.092; 95% CI (-2.419 – -1.766)]. There was no difference in the mean hemoglobin change after either EBL or ETT [MD 0.920; 95% CI (0.392 – 1.449)]. There was a trend towards a lower average of required sessions with EBL compared to APC, but that was not statically significant [MD -1.135; 95% CI (-2.271 - 0.001)]. While the number of procedures required and the post-procedural hemoglobin changes are not different between bleeding GAVE patients treated with EBL and those treated with ETT, the lower transfusion requirements may lead to decreased healthcare burden and costs.