Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Aims Gastric antral vascular ectasia (GAVE) is a condition that frequently carries high morbidity and financial impact. Patients with GAVE typically present occult or overt gastrointestinal bleeding and often become dependent on blood transfusions. Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for this condition, despite considerable recurrence rates. Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility, efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review and meta-analysis including only randomized controlled trials (RCT) of this topic.

Methods A comprehensive search was done of electronic databases (MEDLINE, Embase, Cochrane, LILACS) and gray literature to identify RCTs comparing APC and EBL for the treatment of GAVE following the PRISMA guidelines.

Results Four RCTs were included, totaling 204 patients. EBL presented higher endoscopic eradication rates (RD: 0.29, 95 % CI [0.14, 0.44], p = 0.0001, I2 = 0 %) and less recurrence of bleeding compared to APC (RD: 0.29, 95 % CI [0.15, 0.44], p < 0.0001, I2 = 0 %). Patients treated with EBL required fewer blood transfusions (MD: 1.49, 95 % CI [0.28, 2.71], p = 0.02, I2 = 96 %) and hospitalizations (MD: 0.29, 95 % CI [0.19, 0.39], p < 0.00001, I2 = 0 %). The number of sessions required for obliteration of the lesions was higher with APC (MD: 1.38, 95 % CI [0.35, 2.42], p = 0.009, I2 = 94 %). There was no difference regarding adverse events (RD: -0.20, 95 %CI [-0.48, 0.07], I2 = 91 %).

Tab.1

	Abdelhalim (2014)	Elhendawy (2015)	Ghobrial (2018)	Al-Wahab (2019)
Recurrence of bleeding	EBL 1/20; APC 7/20	EBL NI; APC NI	EBL 1/20; APC 7/20	EBL 3/18; APC 8/18
Endoscopic eradication	EBL 19/20; APC 12/20	EBL NI; APC NI	EBL 19/20; APC 12/20	EBL 13/18; APC 10/18
Mean number of hospitalizations	EBL 0.05 ± 0.22; APC 0.5 ± 0.95	EBL NI; APC NI	EBL 0.67± 0.15; APC 0.95± 0.18	EBL NI; APC NI
Transfusion requirements (units)	EBL 0.15 ± 0.67; APC 2.00 ± 2.97	EBL 2.5 ± 0.70; APC 4.6 ± 0.89	EBL 0.44± 0.1; APC 1.0± 0.67	EBL NI; APC NI

Conclusions EBL and APC are both efficient and safe procedures for endoscopic treatment of GAVE. Nevertheless, EBL is superior in terms of endoscopic eradication rates, recurrence of bleeding, and transfusion requirements.

Citation: Hirsch BS, Ribeiro IB, Funari MP et al. eP86 ENDOSCOPIC BAND LIGATION VERSUS ARGON PLASMA COAGULATION IN THE TREATMENT OF GASTRIC ANTRAL VASCULAR ECTASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Endoscopy 2021; 53: S124.

Publication History

Article published online:
19 March 2021