To coagulate, ligate, or both: a randomized study comparing the safety and efficacy of two endoscopic approaches for managing gastric antral vascular ectasia in cirrhotic patients

Background Gastric antral vascular ectasia (GAVE) is an uncommon but important cause of gastrointestinal bleeding in cirrhotic patients. Argon plasma coagulation (APC) is the standard therapy for GAVE. Endoscopic band ligation (EBL) is an emerging, safe and effective treatment for GAVE. The best way of applying EBL in the management of GAVE is not clear yet. Aim We aimed to determine the safety and efficacy of APC alternating with EBL versus EBL alone for managing GAVE in cirrhotic patients. Patients and methods Forty cirrhotic patients with bleeding GAVE were randomized to receive either APC alternating with EBL (20 patients) or EBL alone (20 patients) until GAVE lesions are eradicated. Gastroscopy was done 6 months after eradication of GAVE lesions to document recurrence. Cessation of bleeding, rise of hemoglobin level, need for transfusion, hospitalization, complications, number of sessions, and recurrence of GAVE in both groups were statistically analyzed. Results Patients in both groups showed significantly high rate of bleeding cessation, improvement in hemoglobin levels, reduction in transfusions, and hospitalizations. There was no statistically significant difference regarding the recurrence of GAVE between the two groups. There were no complications seen in the combined therapy group. Twenty percent of the patients in the EBL group had complications including hypertrophied polyp formation and post-band ulcerations. Conclusion APC alternating with EBL and EBL alone are effective methods in the treatment of bleeding GAVE. Combined therapy has the potential to decrease the number of banding sessions and the number of rubber bands required to treat GAVE, consequently decreasing the incidence of band-related complications.