Comparative Analysis of Etiology, Characteristics, Treatment, and Outcomes in Gastric Antral Vascular Ectasia: A Retrospective Single-Center Study

Introduction: Gastric antral vascular ectasia (GAVE) is a rare gastrointestinal bleeding disorder frequently associated with cirrhosis, systemic sclerosis, connective tissue diseases, and chronic kidney disease (CKD). The management of GAVE involves a range of medical, endoscopic, and surgical interventions. Argon plasma coagulation (APC) has emerged as a commonly employed treatment approach for GAVE. However, the efficacy of APC in the management of GAVE remains uncertain. Thus, this study aims to investigate GAVE's etiology, characteristics, and treatment outcomes. Methods: We conducted a retrospective study to assess patients diagnosed with GAVE. GAVE patients were stratified into three subgroups of GAVE-associated conditions: CKD, cirrhosis, and scleroderma. Patients' data were retrieved from the NYU Langone healthcare system electronic medical records from 2012 to 2023, and IRB exemption was obtained. Results: This study enrolled 124 patients diagnosed with GAVE, including 42 patients (33.9%) with coexisting CKD, 27 patients (21.8%) with cirrhosis, 16 patients (12.9%) with scleroderma, and 39 patients (31.5%) with none of the three comorbidities above. Alcoholic cirrhosis (29.6%) and NASH/NAFLD (22.2%) were the dominant etiologies of cirrhosis in individuals with GAVE. GAVE patients with cirrhosis and CKD exhibited a higher risk of active bleeding during EGD (62.9% and 42.9%, respectively), a higher rate of blood transfusion (85.2% and 52.4%), and a higher mortality (29.6% and 28.6%) than with scleroderma. Proton pump inhibitors were administered to all the GAVE patients. Argon plasma coagulation (APC) (69.4%) is the most common endoscopic intervention among all GAVE patients, followed by band ligation (BL) (11.3%) and radiofrequency ablation (RFA) (6.5%). Of GAVE patients receiving APC, patients with cirrhosis received more therapy sections than those with CKD and scleroderma. Conclusion: Based on our study, scleroderma patients with GAVE have the best prognosis by showing a lower rate of mortality, fewer active bleeding during EGD, fewer transfusions and fewer APC sessions than those with CKD and cirrhosis. On the other hand, cirrhotic patients had the worst clinical outcome. APC emerged as the predominant first-line endoscopic therapy for all GAVE, yet multiple treatment sessions were mainly required. While BL and RFA have been used on certain GAVE patients with cirrhosis and CKD, the efficacy of those 2 in scleroderma patients remained unclear (Table 1). Table 1. - Summary of GAVE patients profile: Clinical characteristics, comorbidities, treatment approaches, and outcomes GAVE with cirrhosis GAVE with CKD GAVE with scleroderma Total Patients number 27 (21.8%) 42 (33.9%) 16 (12.9%) 124 (100%) Mean age 69.3 77.1 73 73.8 Gender Male 12 (44.4%) 25 (59.5%) 4 (25%) 56 (45.2%) Female 15 (55.6%) 17 (40.5%) 12 (75%) 68 (54.8%) Mortality 8 (29.6%) 12 (28.6%) 1 (6.25%) 19 (15.3%) Etiology of cirrhosis - - - Alcoholic 8 (29.6%) NASH/NAFLD 6 (22.2%) HBV 1 (3.7%) HCV 2 (7.4%) HCC 1 (3.7%) AIH 1 (3.7%) Schistosomiasis 1 (3.7%) Amiodarone 1 (3.7%) Cryptogenic 2 (7.4%) Unspecified 4 (14.8) Active bleeding from GAVE during EGD 17 (62.9%) 18 (42.9%) 2 (12.5%) 39 (31.5%) Hx of transfusion Yes 23 (85.2%) 22 (52.4%) 7 (43.75%) 55 (44.4%) No 4 (14.8%) 20 (47.6%) 9 (56.25) 69 (55.6%) Treatment of GAVE PPI 27 (100%) 42 (100%) 16 (100%) 124 (100%) APC 24 (88.9%) 31 (73.8%) 10 (62.5%) 86 (69.4%) BL 12 (44.4%) 6 (14.3%) 0 14 (11.3%) RFA 2 (11.1%) 2 (4.7%) 1 (6.25%) 8 (6.5%) If they do APC, Mean of APC sessions 3.24 ± 1.98 2.73 ± 1.95 2.5 ± 1.90 2.34 ± 1.71