Endoscopic band ligation compared to thermal therapy for gastric antral vascular ectasia: A systematic review and meta-analysis

Background Gastric antral vascular ectasia is an infrequent cause of gastrointestinal-related blood loss manifesting as iron-deficiency anemia or overt gastrointestinal bleeding, and is associated with increased healthcare burdens. Endoscopic therapy of gastric antral vascular ectasia most commonly involves endoscopic thermal therapy. Endoscopic band ligation has been studied as an alternative therapy with promising results in gastric antral vascular ectasia. Aims The primary aim was to compare the efficacy of endoscopic band ligation and endoscopic thermal therapy by argon plasma coagulation for the management of bleeding gastric antral vascular ectasia in terms of the mean post-procedural transfusion requirements and the mean hemoglobin level change. Secondary outcomes included a comparison of the number of sessions needed for cessation of bleeding, the change in transfusion requirements, and the adverse events rate. Methods PubMed, Medline, SCOPUS, Google Scholar, and the Cochrane Controlled Trials Register were reviewed. Randomized controlled clinical trials and retrospective studies comparing endoscopic band ligation and endoscopic thermal therapy in bleeding gastric antral vascular ectasia, with a follow-up period of at least 6 months, were included. Statistical analysis was done using Review Manager. Results Our search yielded 516 papers. After removing duplicates and studies not fitting the criteria of selection, five studies including 207 patients were selected for analysis. Over a follow-up period of at least 6 months, patients treated with endoscopic band ligation had significantly lower post-procedural transfusion requirements (MD −2.10; 95% confidence interval (−2.42 − −1.77)) and a significantly higher change in the mean hemoglobin with endoscopic band ligation vs endoscopic thermal therapy (MD 0.92; 95% confidence interval (0.39 − 1.45)). Endoscopic band ligation led to a fewer number of required sessions (MD −1.15; 95% confidence interval (−2.30 − −0.01)) and a more pronounced change in transfusion requirements (MD −3.26; 95% confidence interval (−4.84 − −1.68)). There was no difference in adverse events. Conclusion Results should be interpreted cautiously due to the limited literature concerning the management of gastric antral vascular ectasia. Compared to endoscopic thermal therapy, endoscopic band ligation for the management of bleeding gastric antral vascular ectasia led to significantly lower transfusion requirements, showed a trend toward more remarkable post-procedural hemoglobin elevation, and a fewer number of procedures. Endoscopic band ligation may improve outcomes and lead to decreased healthcare burden and costs.

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Long-term follow-up in patients with gastric antral vascular ectasia (GAVE) after treatment with endoscopic band ligation (EBL)

Endoscopy International Open ◽

10.1055/a-0977-2870 ◽

2019 ◽

Vol 07 (12) ◽

pp. E1624-E1629 ◽

Cited By ~ 1

Author(s):

John Eccles ◽

Vanessa Falk ◽

Aldo J. Montano-Loza ◽

Sergio Zepeda-Gómez

Keyword(s):

Clinical Response ◽

Argon Plasma Coagulation ◽

Deficiency Anemia ◽

Gastric Antral Vascular Ectasia ◽

Band Ligation ◽

Vascular Ectasia ◽

Transfusion Requirements ◽

Endoscopic Band Ligation

Abstract Background and study aims Gastric antral vascular ectasia (GAVE) is a capillary-type vascular malformation of the gastric antrum, usually diagnosed endoscopically in patients presenting with iron deficiency anemia or gastrointestinal bleeding. While there is established evidence for treatment with thermal modalities, such as argon plasma coagulation (APC) therapy, more recent studies have shown endoscopic band ligation (EBL) to be safe and effective in achieving remission. Our study aimed to evaluate long-term outcomes of patients with GAVE who underwent EBL at our institution. Patients and methods We retrospectively reviewed data from 33 patients with GAVE who underwent esophagogastroduodenoscopy and EBL between September 2012 and July 2017 within our institution, looking primarily at clinical response, recurrence, and blood transfusion requirements. Results Clinical response was achieved in 27 patients (81.8%). Among responders, recurrence-free survival decreased with time from 88 % at 1 year to 44 % at 2 years. Thirteen patients (48.1 %) had recurrence of GAVE at a mean time of 18.2 months (range 4.7 – 51.8). The only predictor of recurrence was greater number of pre-procedure blood transfusions. Conclusion This is the first study to evaluate long-term response and recurrence in patients with GAVE after treatment with EBL and predictors of clinical response after initial endoscopic therapy have been identified. While we were able to demonstrate excellent remission achievement rates in our GAVE patients who had undergone EBL, close clinical follow-up is clearly required as almost 50 % will have recurrence at around 18 months.

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

The American Journal of Gastroenterology ◽

10.14309/00000434-201210001-00661 ◽

2012 ◽

Vol 107 ◽

pp. S273-S274

Author(s):

Veronica Baptista ◽

Neil Marya ◽

David Cave

Keyword(s):

Argon Plasma Coagulation ◽

Argon Plasma ◽

Thermal Therapy ◽

Gastric Antral Vascular Ectasia ◽

Band Ligation ◽

Plasma Coagulation ◽

Vascular Ectasia ◽

Endoscopic Band Ligation

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Endoscopic Band Ligation (EBL) Is Superior to Endoscopic Thermal Therapy (ETT) for the Treatment of Gastric Antral Vascular Ectasia (GAVE) – A Case Control Study

The American Journal of Gastroenterology ◽

10.14309/00000434-200609001-01373 ◽

2006 ◽

Vol 101 ◽

pp. S526

Author(s):

Christopher D. Wells ◽

M. E. Harrison ◽

Suryakanth R. Gurudu ◽

Virender K. Sharma

Keyword(s):

Case Control Study ◽

Case Control ◽

Thermal Therapy ◽

Gastric Antral Vascular Ectasia ◽

Band Ligation ◽

Vascular Ectasia ◽

Endoscopic Band Ligation ◽

Control Study

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

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.3657 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB584

Author(s):

Jean M. Chalhoub ◽

Jalaluddin Umar ◽

Kevin Groudan ◽

Nour Hamade ◽

Yesenia Greeff

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Thermal Therapy ◽

Gastric Antral Vascular Ectasia ◽

Band Ligation ◽

Vascular Ectasia ◽

Endoscopic Band Ligation

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Endoscopic band ligation in the treatment of gastric antral vascular ectasia: a systematic review and meta-analysis

Endoscopy International Open ◽

10.1055/a-1401-9880 ◽

2021 ◽

Vol 09 (07) ◽

pp. E1145-E1157

Author(s):

Thomas R. McCarty ◽

Kelly E. Hathorn ◽

Walter W. Chan ◽

Kunal Jajoo

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Argon Plasma Coagulation ◽

Meta Analysis ◽

Argon Plasma ◽

Mean Difference ◽

Gastric Antral Vascular Ectasia ◽

Band Ligation ◽

Vascular Ectasia ◽

Endoscopic Band Ligation

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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