Argon Plasma Coagulation or Endoscopic Band Ligation for Gastric Antral Vascular Ectasia: A Comparative Analysis

Background: Gastric antral vascular ectasia (GAVE) causes iron-deficiency anemia and gastrointestinal bleeding, albeit uncommonly. Some patients need frequent transfusions. While APC effectively treats lesions, new methods like endoscopic band ligation (EBL) in periodic manner are being explored.

Aim: The study assessed APC versus EBL for GAVE treatment, focusing on lesion obliteration and session frequency. Also evaluated, were pre- and posttreatment hemoglobin, hospitalizations, and transfusion requirements

Methods: The Department of Gastroenterology, SMS Medical College and Associated Hospital, Jaipur, conducted a single-center, prospective, open-label, randomized controlled study. 60 participants with UGI bleeding from GAVE, confirmed by esophagogastroduodenoscopy (EGD), were chosen. Participants without prior GAVE endotherapy were divided into two groups: APC (30) and EBL (30). Sessions were held every 3 to 4 weeks until GAVE lesions cleared. Afterward, patients followed monthly for 6 months. The study is registered as CTRI Reg. No. CTRI/2023/10/058739.

Results: Outcome analysis compared 27 participants in the EBL group to 29 in the APC group. Both groups had similar baseline parameters. EBL required fewer treatment sessions (2.9 ± 0.6) than APC (3.2 ± 0.7). EBL achieved endoscopic obliteration earlier than APC (p < 0.01). At 6 months, both groups showed comparable bleeding control and lesion obliteration. Initially, both groups had similar hemoglobin levels, prior hospitalizations, and transfusion needs. After 6 months, the EBL group had better hemoglobin levels, fewer transfusions (nonsignificant), and fewer hospital visits (p = 0.001) as compared to APC group. While analyzing both groups separately, the pre- and post-intervention values differ significantly in terms of hemoglobin values, hospitalization, and need for transfusion, with a p-value <0.01.

Conclusion: Both EBL and APC are effective in treating GAVE lesions and relieving associated symptoms. Although outcomes were mostly comparable, EBL exhibited benefits in treatment duration, hospital stays and hemoglobin changes. Nonetheless, more comprehensive, long-term data is needed.

Publication History

Article published online:
22 April 2024