Endoscopy 2021; 53(S 01): S124-S125
DOI: 10.1055/s-0041-1724585
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Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

BS Hirsch
1   Hospital das Clínicas, University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
IB Ribeiro
1   Hospital das Clínicas, University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
MP Funari
1   Hospital das Clínicas, University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
DTH de Moura
1   Hospital das Clínicas, University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
SE Matuguma
1   Hospital das Clínicas, University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
S Sanchez-Luna
2   Center for Advanced Therapeutic Endoscopy, Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh, United States
,
GdO Luz
1   Hospital das Clínicas, University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
FC Mancini
1   Hospital das Clínicas, University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
GHP de Oliveira
1   Hospital das Clínicas, University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
WM Bernardo
1   Hospital das Clínicas, University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
EGH de Moura
1   Hospital das Clínicas, University of São Paulo School of Medicine, Gastrointestinal Endoscopy Unit, São Paulo, Brazil
› Author Affiliations
 
 

    Aims Gastric antral vascular ectasia (GAVE) is a condition that frequently carries high morbidity and financial impact. Patients with GAVE typically present occult or overt gastrointestinal bleeding and often become dependent on blood transfusions. Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for this condition, despite considerable recurrence rates. Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility, efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review and meta-analysis including only randomized controlled trials (RCT) of this topic.

    Methods A comprehensive search was done of electronic databases (MEDLINE, Embase, Cochrane, LILACS) and gray literature to identify RCTs comparing APC and EBL for the treatment of GAVE following the PRISMA guidelines.

    Results Four RCTs were included, totaling 204 patients. EBL presented higher endoscopic eradication rates (RD: 0.29, 95 % CI [0.14, 0.44], p = 0.0001, I2 = 0 %) and less recurrence of bleeding compared to APC (RD: 0.29, 95 % CI [0.15, 0.44], p < 0.0001, I2 = 0 %). Patients treated with EBL required fewer blood transfusions (MD: 1.49, 95 % CI [0.28, 2.71], p = 0.02, I2 = 96 %) and hospitalizations (MD: 0.29, 95 % CI [0.19, 0.39], p < 0.00001, I2 = 0 %). The number of sessions required for obliteration of the lesions was higher with APC (MD: 1.38, 95 % CI [0.35, 2.42], p = 0.009, I2 = 94 %). There was no difference regarding adverse events (RD: -0.20, 95 %CI [-0.48, 0.07], I2 = 91 %).

    Tab.1

    Abdelhalim (2014)

    Elhendawy (2015)

    Ghobrial (2018)

    Al-Wahab (2019)

    Recurrence of bleeding

    EBL 1/20; APC 7/20

    EBL NI; APC NI

    EBL 1/20; APC 7/20

    EBL 3/18; APC 8/18

    Endoscopic eradication

    EBL 19/20; APC 12/20

    EBL NI; APC NI

    EBL 19/20; APC 12/20

    EBL 13/18; APC 10/18

    Mean number of hospitalizations

    EBL 0.05 ± 0.22; APC 0.5 ± 0.95

    EBL NI; APC NI

    EBL 0.67± 0.15; APC 0.95± 0.18

    EBL NI; APC NI

    Transfusion requirements (units)

    EBL 0.15 ± 0.67; APC 2.00 ± 2.97

    EBL 2.5 ± 0.70; APC 4.6 ± 0.89

    EBL 0.44± 0.1; APC 1.0± 0.67

    EBL NI; APC NI

    Conclusions EBL and APC are both efficient and safe procedures for endoscopic treatment of GAVE. Nevertheless, EBL is superior in terms of endoscopic eradication rates, recurrence of bleeding, and transfusion requirements.

    Citation: Hirsch BS, Ribeiro IB, Funari MP et al. eP86 ENDOSCOPIC BAND LIGATION VERSUS ARGON PLASMA COAGULATION IN THE TREATMENT OF GASTRIC ANTRAL VASCULAR ECTASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Endoscopy 2021; 53: S124.


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    Publication History

    Article published online:
    19 March 2021

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