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 < 0.05). Moreover, EBL was significantly superior to APC with respect to lower rate of recurrence during the treatment and follow-up period (P < 0.05) and a higher rate of endoscopic cure after the follow-up period (P < 0.05). Hemoglobin levels increased significantly after obliteration of the lesions in both groups, compared with pretreatment values (P < 0.05), but with no significant difference between the two groups; however, the EBL group required a significantly smaller number of units of blood transfusion than the APC group (P < 0.05), greater decrease in hospital admissions (P < 0.05), and shorter procedure time (P < 0.05). Postprocedural abdominal pain and vomiting occurred more frequently in the EBL group, with a significant difference (P < 0.05). No major complications or deaths were observed during the study period. 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.

Keywords

• anemia
• argon plasma coagulation
• endoscopic band ligation
• gastric antral vascular ectasia