Is Endoscopic Band Ligation a Superior Treatment Modality for Gastric Antral Vascular Ectasia Compared to Argon Plasma Coagulation?
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Background/Aims: Gastric antral vascular ectasia (GAVE) is a rare acquired vascular lesion of the gastric antrum. The most frequentpresentation of GAVE is iron deficiency anemia. Endoscopic therapy is the mainstay of treatment. However, there is no consensusregarding the optimal treatment modality. Methods: A retrospective cohort study was performed on patients with GAVE, including patients receiving endoscopic therapy. Treatment was with either argon plasma coagulation (APC) or endoscopic band ligation (EBL). Basic demographic data, indicationfor index procedure, number of sessions, and pre- and post-hemoglobin levels were collected. The aim of the study was to compareoutcomes across the two treatment modalities. Results: One hundred and seventeen diagnoses of GAVE were made. Sixty-two patients (53%) required endoscopic treatment forsymptomatic GAVE (female, n=38, 61%; mean age of 74.4 years). Two hundred and eighteen procedures were performed duringthe study period. APC was performed (n=161, 74%) more frequently than EBL (n=57, 26%). Patients treated with APC at indexrequired a median 5 subsequent therapeutic interventions (APC or EBL), while those treated with EBL at index required a further 2.9treatments (EBL only) (p<0.05). Conclusions: APC was the most common treatment modality employed. We demonstrate an increasing incidence of EBL. Patientstreated with EBL at index treatment required fewer subsequent treatment sessions and had a greater mean rise in hemoglobin. Thissuggests a more effective endoscopic response with EBL.
Abstract
Background/Aims: Gastric antral vascular ectasia (GAVE) is a rare acquired vascular lesion of the gastric antrum. The most frequentpresentation of GAVE is iron deficiency anemia. Endoscopic therapy is the mainstay of treatment. However, there is no consensusregarding the optimal treatment modality. Methods: A retrospective cohort study was performed on patients with GAVE, including patients receiving endoscopic therapy. Treatment was with either argon plasma coagulation (APC) or endoscopic band ligation (EBL). Basic demographic data, indicationfor index procedure, number of sessions, and pre- and post-hemoglobin levels were collected. The aim of the study was to compareoutcomes across the two treatment modalities. Results: One hundred and seventeen diagnoses of GAVE were made. Sixty-two patients (53%) required endoscopic treatment forsymptomatic GAVE (female, n=38, 61%; mean age of 74.4 years). Two hundred and eighteen procedures were performed duringthe study period. APC was performed (n=161, 74%) more frequently than EBL (n=57, 26%). Patients treated with APC at indexrequired a median 5 subsequent therapeutic interventions (APC or EBL), while those treated with EBL at index required a further 2.9treatments (EBL only) (p<0.05). Conclusions: APC was the most common treatment modality employed. We demonstrate an increasing incidence of EBL. Patientstreated with EBL at index treatment required fewer subsequent treatment sessions and had a greater mean rise in hemoglobin. Thissuggests a more effective endoscopic response with EBL.
참고문헌 (24)
- Suit PF, "Gastric antral vascular ectasia. A histologic and morphometric study of"the watermelon stomach"", Am J Surg Pathol, 11, pp.750~757 (1987)
- Gilliam JH 3rd, "Endoscopic biopsy is diagnostic in gastric antral vascular ectasia. The"watermelon stomach"", Dig Dis Sci, 34, pp.885~888 (1989)
- Lewis TD, "Arteriovenous malformation of the stomach. Radiologic and endoscopic features", Am J Dig Dis, 23, pp.467~471 (1978)
- Jabbari M, "Gastric antral vascular ectasia : the watermelon stomach", Gastroenterology, 87, pp.1165~1170 (1984)
- Petrini JL Jr, "Heat probe treatment for antral vascular ectasia", Gastrointest Endosc, 35, pp.324~328 (1989)
- Binmoeller KF, "Bipolar electrocoagulation for watermelon stomach", Gastrointest Endosc, 36, pp.399~402 (1990)
- Rose JD, "Endoscopic injection of alcohol for bleeding from gastroduodenal vascular anomalies", Br Med J(Clin Res Ed), 295, pp.93~94 (1987)
- Sargeant IR, "Laser ablation of upper gastrointestinal vascular ectasias : long term results", Gut, 34, pp.470~475 (1993)
- Wahab PJ, "Argon plasma coagulation in flexible gastrointestinal endoscopy : pilot experiences", Endoscopy, 29, pp.176~181 (1997)
- Herrera S, "The beneficial effects of argon plasma coagulation in the management of different types of gastric vascular ectasia lesions in patients admitted for GI hemorrhage", Gastrointest Endosc, 68, pp.440~446 (2008)
- Kwan V, "Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions : experience in 100 consecutive patients with long-term follow-up", Am J Gastroenterol, 101, pp.58~63 (2006)
- Chaves DM, "Watermelon stomach : clinical aspects and treatment with argon plasma coagulation", Arq Gastroenterol, 43, pp.191~195 (2006)
- Yusoff I, "Argon plasma coagulation for treatment of watermelon stomach", Endoscopy, 34, pp.407~410 (2002)
- Boltin D, "Long-term treatment outcome of patients with gastric vascular ectasia treated with argon plasma coagulation", Eur J Gastroenterol Hepatol, 26, pp.588~593 (2014)
- Nakamura S, "Longterm follow up of gastric antral vascular ectasia treated by argon plasma coagulation", Dig Endosc, 18, pp.128~133 (2006)
- Garg S, "Endoscopic resolution and recurrence of gastric antral vascular ectasia after serial treatment with argon plasma coagulation", World J Gastrointest Endosc, 9, pp.263~266 (2017)
- Jana T, "Radiofrequency ablation for treatment of refractory gastric antral vascular ectasia(with video)", Endosc Int Open, 3, pp.E125~E127 (2015)
- Magee C, "Radiofrequency ablation for patients with refractory symptomatic anaemia secondary to gastric antral vascular ectasia", United European Gastroenterol J, 7, pp.217~224 (2019)
- Wells CD, "Treatment of gastric antral vascular ectasia(watermelon stomach)with endoscopic band ligation", Gastrointest Endosc, 68, pp.231~236 (2008)
- Keohane J, "Band ligation of gastric antral vascular ectasia is a safe and effective endoscopic treatment", Dig Endosc, 25, pp.392~396 (2013)
- Zepeda-Gómez S, "Gastric antral vascular ectasia : a prospective study of treatment with endoscopic band ligation", Endoscopy, 47, pp.538~540 (2015)
- Sato T, "Endoscopic band ligation versus argon plasma coagulation for gastric antral vascular ectasia associated with liver diseases", Dig Endosc, 24, pp.237~242 (2012)
- Eccles J, "Long-term follow-up in patients with gastric antral vascular ectasia(GAVE)after treatment with endoscopic band ligation(EBL)", Endosc Int Open, 7, pp.E1624~E1629 (2019)
- Polski JM, "Chronology of histological changes after band ligation of esophageal varices in humans", Endoscopy, 33, pp.443~447 (2001)