BURNING DOWN THE HOUSE: DOES ENDOSCOPIC BAND LIGATION FOR THE TREATMENT OF GAVE RESULT IN BETTER OUTCOMES COMPARED TO ARGON PHOTO COAGULATION?

Aims:

Gastric antral vascular ectasia (GAVE) is a rare vascular malformation located primarily in the antrum. While Argon Photo Coagulation (APC) is the current standard of care, Endoscopic Band Ligation (EBL) is increasingly used. There is currently no consensus regarding the optimal treatment modality, as current available evidence is limited to small case series. We aimed to compare outcomes following each treatment modality.

Methods:

A retrospective cohort study was performed of patients with an endoscopic diagnosis of GAVE recorded in our tertiary referral University hospital (04/2013-present). All patients receiving endoscopic therapy for GAVE were included in the study.

Results:

In total, 117 diagnoses of GAVE were made during the study period. Of these, 68 patients (58%) required treatment, with a female preponderance (n = 39, 57%) and a mean age of 74.1 (range 45 – 95). A total of 220 procedures were performed, with an average of 3.2 treatment sessions per patient (range 1 – 20). Iron deficiency anaemia (n = 40, 59%) was the most common indication with melaena (19%), previously untreated GAVE follow up (15%), varices surveillance (4%) and haematemesis (3%) also reported. APC was the most common procedure performed (n = 167, 74%) compared with EBL (n = 59, 26%). Patients treated with EBL as the index treatment required a mean of 2.1 subsequent treatments, compared to a mean of 3.5 treatment sessions in the APC group. The pooled mean rise in haemoglobin one month post procedure was higher in the EBL group (1.1 g/dL vs. 0.6 g/dL).

Conclusions:

We report our experience in the largest cohort to date of patients treated with EBL for GAVE. Patients treated with EBL at the index treatment required fewer subsequent treatment sessions and had a greater mean rise in haemoglobin post treatment, suggesting EBL as the initial treatment may lead to better outcomes.