213 Comparative Effectiveness of Radiofrequency Ablation and Argon Plasma Coagulation for Treatment of Gastric Antral Vascular Ectasia: a Systematic Review and Meta-Analysis

Abstract Background and study aims While argon plasma coagulation (APC) is the first-line treatment for gastric antral vascular ectasia (GAVE), endoscopic band ligation (EBL) has shown promising results. The aim of this study was to perform a systematic review and meta-analysis to evaluate the effectiveness of EBL for the treatment of GAVE. Methods Individualized search strategies were developed in accordance with PRISMA and MOOSE guidelines through September 1, 2020. Measured outcomes included endoscopic success (defined as GAVE eradication/improvement), change in hemoglobin, transfusion dependency, number of treatment sessions, adverse events, rebleeding, and bleeding-associated mortality. Outcomes were compared among studies evaluating EBL versus APC. Results Eleven studies (n = 393; 59.39 % female; mean age 58.65 ± 8.85 years) were included. Endoscopic success was achieved in 87.84 % [(95 % CI, 80.25 to 92.78); I2 = 11.96 %] with a mean number of 2.50 ± 0.49 treatment sessions and average of 12.40 ± 3.82 bands applied. For 8 studies comparing EBL (n = 143) versus APC (n = 174), there was no difference in baseline patient characteristics. However, endoscopic success was significantly higher for EBL [OR 6.04 (95 % CI 1.97 to 18.56; P = 0.002], requiring fewer treatment sessions (2.56 ± 0.81 versus 3.78 ± 1.17; P < 0.001). EBL was also associated with a greater increase in post-procedure hemoglobin [mean difference 0.35 (95 % CI 0.07 to 0.62; P = 0.0140], greater reduction in transfusions required [mean difference –1.46 (95 % CI –2.80 to –0.12; P = 0.033], and fewer rebleeding events [OR 0.11 (95 % CI, 0.04 to 0.36); P < 0.001]. There was no difference in adverse events or bleeding-associated mortality (P > 0.050). Conclusions EBL appears to be safe and effective for treatment of GAVE, with improved outcomes when compared to APC.

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Radiofrequency ablation (RFA) vs. argon plasma coagulation (APC) for the management of gastric antral vascular ectasia (GAVE) in patients with and without cirrhosis: results from a retrospective analysis of a large cohort of patients treated at a single center

Endoscopy International Open ◽

10.1055/s-0043-123187 ◽

2018 ◽

Vol 06 (03) ◽

pp. E266-E270 ◽

Cited By ~ 4

Author(s):

Paul St Romain ◽

Amanda Boyd ◽

Jiayin Zheng ◽

Shein-Chung Chow ◽

Rebecca Burbridge ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Response To Treatment ◽

Treatment Modalities ◽

Gastric Antral Vascular Ectasia ◽

Chi Square ◽

Similar Time ◽

Plasma Coagulation ◽

Vascular Ectasia

Abstract Introduction and study aims Gastric antral vascular ectasia (GAVE) is a mucosal abnormality associated with multiple conditions, most notably cirrhosis and systemic sclerosis, that causes indolent gastrointestinal bleeding. It is primarily managed with endoscopic therapy. Traditionally, GAVE is endoscopically ablated using argon plasma coagulation (APC) but radiofrequency ablation (RFA) is emerging as an alternative modality. No prior comparison of the 2 modalities has been published. We retrospectively compared the effects of GAVE ablation with either RFA, APC or both in the largest cohort of patients thus far presented. We also attempt to discern what effect concomitant cirrhosis has on response to treatment. Patients and methods After receiving IRB approval, we reviewed our electronic health records to identify all patients who underwent endoscopic evaluation for GAVE between January, 2011 and October, 2016. We compared important variables between APC and RFA, as well as between cirrhosis and non-cirrhosis, using the Chi-square test and the Wilcoxon two-sample test as appropriate. Results During our study period, 81 patients were endoscopically evaluated for GAVE. 24 patients were treated with APC alone, 28 with RFA alone and 25 patients received both treatment modalities. APC-treated patients underwent a mean of 2.4 treatment sessions with a mean of 205 days between treatments. RFA-treated patients underwent a mean of 2.3 treatment sessions with a mean of 100 days between treatments. Hemoglobin values remained stable or increased in all patients during our study period and there were no significant differences in Hgb trend between those treated with APC and those with RFA. Conclusions RFA and APC were both effective in treating bleeding from GAVE. Though we found subtle differences, patients underwent a similar number of treatment sessions and had similar procedure times and a similar time between sessions no matter the treatment modality used.

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Endoscopic mucosal resection for recurrent gastric antral vascular ectasia

VASA ◽

10.1024/0301-1526.37.3.289 ◽

2008 ◽

Vol 37 (3) ◽

pp. 289-292 ◽

Cited By ~ 5

Author(s):

Katsinelos ◽

Chatzimavroudis ◽

Katsinelos ◽

Panagiotopoulou ◽

Kotakidou ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Deficiency Anemia ◽

Gastric Antral Vascular Ectasia ◽

Therapeutic Approaches ◽

Plasma Coagulation ◽

Vascular Ectasia ◽

Mucosal Resection ◽

First Case

Gastric antral vascular ectasia (GAVE) is an overt or occult source of gastrointestinal bleeding. Despite several therapeutic approaches have been successfully tested for preventing chronic bleeding, some patients present recurrence of GAVE lesions. To the best of our knowledge, we report the first case, of a 86-year-old woman who presented severe iron-deficiency anemia due to GAVE and showed recurrence of GAVE lesion despite the intensive argon plasma coagulation treatment. We performed endoscopic mucosal resection of bleeding GAVE with resolution of anemia.

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