Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation.
BACKGROUND
Gastric antral vascular ectasia (GAVE) is characterized by mucosal and submucosal vascular ectasia causing recurrent GI hemorrhage. Treatment of GAVE with endoscopic thermal therapy (ETT) requires multiple sessions for destruction of vascular ectasia and control of bleeding. Endoscopic band ligation (EBL) has become the standard treatment of varices because it effectively obliterates the submucosal plexus of esophageal varices with an acceptably low rate of complications. Additionally, EBL has been used for control of bleeding from other GI vascular lesions. In patients with GAVE and recurrent GI hemorrhage, EBL may offer an alternative to ETT for treatment of large areas of diseased mucosa and submucosa.


OBJECTIVE
Our purpose was to compare EBL (n = 9) with ETT (n = 13) for the treatment of bleeding from GAVE.


METHODS
Observational comparative study.


METHODS
Patients with gastric antral vascular ectasia with occult or overt bleeding.


METHODS
Mayo Clinic Arizona, a multispecialty academic medical center.


METHODS
EBL or ETT with argon plasma coagulation or electrocautery.


METHODS
Number of treatments to cessation of bleeding and posttreatment hemoglobin, hospitalization, and transfusion requirement.


RESULTS
There were no significant differences in the demographics, clinical presentation, associated portal hypertension, or mean hemoglobin values or the mean number of transfusions or hospitalizations between the 2 groups before treatment. Four patients in the EBL group had failed prior ETT. Compared with ETT, in exploratory statistical testing EBL had a significantly higher rate of bleeding cessation (67% vs 23%, P = .04), fewer treatment sessions required for cessation of bleeding (1.9 vs 4.7, P = .05), a greater increase in hemoglobin values (2.8 g/dL vs 0.9 g/dL, P = .05), a greater decrease in transfusion requirements (-12.7 vs -5.2, P = .02), and a greater decrease in hospital admissions (-2.6 vs -0.5, P = .02) during the follow-up period. Analysis of covariance showed significantly superior efficacy of EBL for cessation of bleeding, postprocedure transfusion, and hospitalization. One patient in the EBL group had postprocedure emesis and 1 in the ETT group had immediate post procedure bleeding. All patients in the EBL group had complete mucosal healing with minimal residual GAVE at follow-up endoscopy failed post-EBL.


CONCLUSIONS
Our initial experience suggests that EBL is superior to ETT for the management of GAVE. EBL required fewer treatment sessions for control of bleeding, had higher rates for cessation of bleeding, had a reduction in hospitalizations and transfusion requirements, and allowed for a significant increase in hemoglobin values.
Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
Christopher D
CD
Wells
M Edwyn
ME
Harrison
Suryakanth R
SR
Gurudu
Michael D
MD
Crowell
Thomas J
TJ
Byrne
Giovanni
G
Depetris
Virender K
VK
Sharma
D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D020252:Gastric Antral Vascular Ectasia / Q000150:complications* / Q000175:diagnosis; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome