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Elhendawy M, Mosaad S, Alkhalawany W, et al. Randomized controlled study of endoscopic band ligation and argon plasma coagulation in the treatment of gastric antral and fundal vascular ectasia. United European Gastroenterol J. 2015;4(3):423-8doi: 10.1177/2050640615619837.
Elhendawy, M., Mosaad, S., Alkhalawany, W., Abo-Ali, L., Enaba, M., Elsaka, A., & Elfert, A. A. (2016). Randomized controlled study of endoscopic band ligation and argon plasma coagulation in the treatment of gastric antral and fundal vascular ectasia. United European gastroenterology journal, 4(3), 423-8. https://doi.org/10.1177/2050640615619837
Elhendawy, Mohammed, et al. "Randomized controlled study of endoscopic band ligation and argon plasma coagulation in the treatment of gastric antral and fundal vascular ectasia." United European gastroenterology journal vol. 4,3 (2016): 423-8. doi: https://doi.org/10.1177/2050640615619837
Elhendawy M, Mosaad S, Alkhalawany W, Abo-Ali L, Enaba M, Elsaka A, Elfert AA. Randomized controlled study of endoscopic band ligation and argon plasma coagulation in the treatment of gastric antral and fundal vascular ectasia. United European Gastroenterol J. 2016 Jun;4(3):423-8. doi: 10.1177/2050640615619837. Epub 2015 Dec 15. PMID: 27403309; PMCID: PMC4924441.
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United European Gastroenterol J. 2016 Jun;4(3):423-8. doi: 10.1177/2050640615619837. Epub 2015 Dec 15.

Randomized controlled study of endoscopic band ligation and argon plasma coagulation in the treatment of gastric antral and fundal vascular ectasia.

United European gastroenterology journal

Mohammed Elhendawy, Samah Mosaad, Walaa Alkhalawany, Lobna Abo-Ali, Mohamed Enaba, Aymen Elsaka, Asem A Elfert

Affiliations

  1. Department of Tropical Medicine, Tanta University Hospital, Egypt.
  2. Department of Internal Medicine, Tanta University Hospital, Egypt.
  3. Department of Pathology, Tanta University Hospital, Egypt.

PMID: 27403309 PMCID: PMC4924441 DOI: 10.1177/2050640615619837

Abstract

BACKGROUND: Gastric antral vascular ectasia (GAVE) is characterized by mucosal and submucosal vascular ectasia causing recurrent hemorrhage and thus, chronic anemia, in patients with cirrhosis. Treatment with argon plasma coagulation (APC) is an effective and safe method, 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 randomized controlled study was to evaluate the safety and efficacy of EBL, as compared to APC, in the treatment of GAVE and gastric fundal vascular ectasia (GFVE).

PATIENTS AND METHODS: A total of 88 cirrhotic patients with GAVE were prospectively randomized to endoscopic treatment with either EBL or APC, every 2 weeks until complete obliteration was accomplished; then they were followed up endoscopically after 6 months, plus they had monthly measurement of hemoglobin levels during that period.

RESULTS: We describe the presence of mucosal and submucosal lesions in the gastric fundal area that were similar to those found in GAVE in 13 patients (29.5%) of the EBL group and 9 patients (20.5%) of the APC group; we named this GFVE. In these cases, we treated the fundal lesions with the same techniques we had used for treating GAVE, according to the randomization. We found that EBL significantly decreased the number of sessions required for complete obliteration of the lesions (2.98 sessions compared to 3.48 sessions in the APC group (p < 0.05)). Hemoglobin levels increased significantly after obliteration of the lesions in both groups, compared to pretreatment values (p < 0.05), but with no significant difference between the two groups (p > 0.05); however, the EBL group of patients required a significantly smaller number of units of blood transfusion than the APC group of patients (p < 0.05). There were no significant differences in adverse events nor complications between the two groups (p > 0.05).

CONCLUSIONS: This study described and histologically proved the presence of GFVE occurring comcomitantly with GAVE in cirrhotic patients. We showed that GFVE can be successfully managed by EBL or APC. Our study revealed that EBL is more effective and is comparable in safety to APC, in the treatment of GAVE and GFVE in cirrhotic patients.

Keywords: Anemia; argon plasma coagulation; cirrhosis; comparative study; endoscopic band ligation; gastric antral vascular ectasia; gastric fundal vascular ectasia; transfusion; treatment techniques

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