Case series
Gastric antral vascular ectasia: a prospective study of treatment with endoscopic band ligation
Authors
Sergio Zepeda-Gómez1, Richard Sultanian1, Christopher Teshima1, Gurpal Sandha1, Sander Van Zanten1, Aldo J. Montano-Loza2
Institutions
1 2
submitted 12. November 2014 accepted after revision 7. December 2014
Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1391395 Published online: 4.2.2015 Endoscopy 2015; 47: 538–540 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X Corresponding author Sergio Zepeda-Gómez, MD Zeidler Ledcor Centre 130 University Campus University of Alberta Edmonton, Alberta T6G 2X8 Canada Fax: +1-780-492-9416 [email protected]
Division of Gastroenterology, University of Alberta Hospital, Edmonton, Alberta, Canada Division of Hepatology, University of Alberta Hospital, Edmonton, Alberta, Canada
Gastric antral vascular ectasia (GAVE) is characterized by red, angiomatous lesions in the antrum organized either in stripes or in a diffuse pattern that can be associated with upper gastrointestinal bleeding. Endoscopic band ligation (EBL) has been reported as an effective alternative therapy for patients with GAVE. Consecutive patients with a diagnosis of GAVE were prospectively followed while undergoing EBL every 2 months. Hemoglobin, ferritin, and iron levels were frequently recorded, and clinical follow-up was performed. A total of 21 patients with GAVE were enrolled, and 17 of these patients (81 %) had associated co-mor-
bidities, most frequently cirrhosis and chronic renal failure. A clinical response was achieved in 19 patients (91 %). A significant improvement in the mean hemoglobin level was noted after EBL (P < 0.001), and a significant decrease in blood transfusion requirements per month (P = 0.001). No major complications were observed during the study period. The mean follow-up was 10 months. EBL is an effective and safe treatment for GAVE. Randomized, controlled trials comparing EBL with other endoscopic therapies are warranted.
Introduction
Patients and methods
!
!
Gastric antral vascular ectasia (GAVE) is a capillary-type vascular malformation located mainly in the gastric antrum. It is characterized by dilated, tortuous mucosal capillaries, which are often occluded by thrombus, as well as by dilated, tortuous submucosal veins [1]. At endoscopy, GAVE may appear as multiple longitudinal streaks that converge at the pyloric orifice (stripe type) or as multiple erythematous spots (diffuse or granular " Fig. 1). Patients with GAVE can be type) [2] (● asymptomatic or may present with iron deficiency anemia or overt gastrointestinal (GI) bleeding. Multiple endoscopic therapies, including Nd:YAG laser therapy, heater probe, monopolar therapy, and argon plasma coagulation (APC), have been reported for the ablation of GAVE [3]. However, the complication rates for these modalities are high (20 % – 33 %), and rates of failed therapy of up to 14 % have been reported [4]. Endoscopic band ligation (EBL) has been reported as an alternative effective endoscopic therapy, and the rate of complications is low in comparison with those reported for APC in retrospective studies [5 – 7]. Therefore, we decided to evaluate the efficacy of EBL for the treatment of GAVE in a prospective study.
All patients 18 years of age and older who underwent upper GI endoscopy between September 2012 and June 2014 and in whom GAVE-associated GI bleeding or GAVE-related iron deficiency anemia was diagnosed were enrolled in the study after they had given informed consent. Patients were excluded if they had received endoscopic treatment for GAVE in the preceding 3 months. Patients who did not have anemia or who had another possible source of upper GI bleeding were also excluded. This study was approved by the University of Alberta Health Research Ethics Board. Demographic and procedure-related data were prospectively recorded. Outcome measures included clinical response (defined by the eradication or near-eradication of GAVE at endoscopic examination along with stabilization of hemoglobin levels and/or a decrease in blood transfusion requirements) and the occurrence of complications. All procedures were performed by three experienced endoscopists (S. Z.-G., R. S., and G. S.). The diagnosis of GAVE was categorized as either stripe type (prominent raised or flat erythematous stripes radiating from the pylorus to the antrum)
Zepeda-Gómez Sergio et al. Endoscopic band ligation treatment of gastric antral vascular ectasia … Endoscopy 2015; 47: 538–540
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
538
Case series
539
or diffuse type (ectasia appearing as many coalescent, round angiodysplastic lesions). The procedures were performed with a diagnostic gastroscope (GIF-H180/GIF-HQ190; Olympus) and the Saeed Multi-Band Ligator (Cook Medical, Bloomington, Indiana, USA). The bands were applied to abnormal-appearing mucosa in the antrum; the application was started in the lesions adjacent to the pylorus, then continued proximally in the antrum in a helicoidal direction until most of the GAVE areas were covered. The number of bands applied was left to the discretion of the endoscopist. In the case of actively bleeding GAVE, the areas with active bleeding were targeted for banding first. The patients were started on proton pump inhibitor therapy (40 mg of pantoprazole every 24 hours), which was continued for at least 4 weeks after EBL. They were advised to stay on a diet of clear fluids and soft food the first 48 hours after the procedure. A second endoscopic evaluation was performed 6 to 8 weeks after the initial treatment, with subsequent gastroscopic examinations conducted at the same interval until a clinical response was achieved. Hemoglobin levels and iron studies were recorded every 4 weeks for at least 6 months after the initial treatment with EBL.
Statistical analysis Categorical variables were analyzed with Fisher’s exact test and dimensional variables with the Mann–Whitney U test. For the analysis of related samples (e. g., hemoglobin levels before and after treatment), the Wilcoxon signed-rank test was used. A P level below 0.05 was considered statistically significant. Results were expressed as proportion or mean with range or 95 % confidence interval (95 %CI).
Results !
A total of 28 patients were evaluated during the study period. Of these, 7 were excluded for the following reasons: endoscopic treatment for GAVE had been administered to 4 patients within the last 3 months, no evidence of anemia was found in 2 patients,
and another source of upper GI bleeding was found in 1 patient, so 21 patients were included in the final analysis. The complete " Tademographic and baseline characteristics are presented in ● ble 1. A clinical response was achieved in 19 patients (91 %) after a mean of 2.28 (range, 1 – 6) endoscopic sessions. The maximum number of bands applied in a single session was 9. A clinical response was not achieved in 2 patients, who continued to require blood transfusions. These 2 patients had chronic renal failure in association with diffuse-type GAVE and required additional APC and EBL treatment. Moderate to severe diffuse abdominal pain developed in 2 patients immediately after the procedure. One of them was admitted overnight and discharged 24 hours later without pain. Neither required any further interventions. No other complications were observed. A significant improvement in the mean hemoglobin level was noted after the last endoscopic treatment session for GAVE compared with the pretreatment hemoglobin level (P < 0.001). In the 13 patients who were dependent on blood transfusions before treatment, the mean number of packed red blood cell transfusions per month was significantly decreased after eradication in comparison with baseline (P = 0.001). A significant improvement in the serum ferritin levels (P = 0.04) was also noted after eradication, as was a trend toward improvement in the serum iron levels (P = " Table 2). 0.09) (●
Discussion !
We present here the results of the first prospective study in which EBL was used to treat consecutive patients with GI bleeding or anemia due to GAVE. Endoscopic improvement with the use of EBL was achieved in 91 % of the patients. This was associated with significant improvements in the hemoglobin and ferritin levels and a reduction in blood transfusion requirements at follow-up. EBL is a relatively easy technique when used for GAVE therapy and has been shown to be safe, with no major complications re-
Zepeda-Gómez Sergio et al. Endoscopic band ligation treatment of gastric antral vascular ectasia … Endoscopy 2015; 47: 538–540
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Fig. 1 Endoscopic views of gastric antral vascular ectasia (GAVE). a Stripe type. b Diffuse type with areas of active bleeding. c After band ligation. d Nearly complete eradication after two sessions of endoscopic band ligation.
Case series
Table 1 Characteristics of the patients at the time of the first endoscopic band ligation (EBL) treatment for gastric antral vascular ectasia (GAVE). Patients (females:males), n
21 (15:6)
Age, mean ± SD (range), y
65 ± 13 (44 – 87)
Co-morbidities, n (%)
17 (81)
Cirrhosis
8 (38)
Chronic renal failure
5 (24)
Scleroderma
1 (5)
Atrial fibrillation
3 (14)
Clinical presentation, n (%) Iron deficiency anemia Overt gastrointestinal bleeding Previous argon plasma coagulation (APC) treatment, n (%) Blood transfusion-dependent patients, n (%)
13 (62) 8 (38) 9 (43) 13 (62)
GAVE type, n (%) Diffuse
12 (57)
Stripe
9 (43)
SD, standard deviation.
Table 2 Outcomes after endoscopic band ligation (EBL) in 21 patients with gastric antral vascular ectasia (GAVE). Follow-up, mean (range), months Sessions needed for eradication, mean (range), n
10 (2 – 17) 2.28 (1 – 6)
Bands applied, mean (range), n
16 (6 – 59)
Clinical response, n (%)
19 (91)
Hematologic parameters Hemoglobin level, mean (95 %CI), g/L Before EBL After EBL P value
88 (101 – 118) 109 (79 – 97)
References
Before EBL
2.85 (2.03 – 3.6)
After EBL
1.15 (0.3 – 2)
P value
0.001
Ferritin level, mean (95 %CI), μg/L Before EBL P value
63 (17.6 – 96.3) 105 (0.18 – 208) 0.04
Iron level, mean (95 % CI), μmol/L Before EBL After EBL P value
Competing interests: None
< 0.001
Total number of PRBC units per month, mean (95 %CI)
After EBL
clude perforation and bleeding, whereas EBL has been associated only with transient abdominal pain. Many issues need to be clarified to improve the treatment of GAVE with EBL. These include determinations of the optimal interval between treatment sessions, the need for combined therapy with APC or other modalities in patients who have a poor response, and the duration and frequency of endoscopic surveillance to look for recurrence after eradication. Although no comparison was made between the treatment efficacy of EBL and that of APC in this study, perhaps it is instructive that 43 % of the patients had undergone multiple failed endoscopic treatment sessions with APC, and in all but one of these patients, a clinical response was achieved with EBL. Given the reduced number of procedures required to achieve a complete endoscopic response with EBL and the reduction in transfusion requirements, EBL is likely to decrease health care costs for this group of patients. However, a randomized, controlled trial will be needed to determine whether EBL is truly superior to APC as the primary endoscopic therapy for GAVE. In summary, our study suggests that EBL constitutes an effective and safe treatment for GAVE, associated with improved hematologic parameters and decreased blood transfusion requirements. The limitations of our study include a relatively small sample and the lack of comparison with other endoscopic techniques. We believe that our data should encourage further clinical trials comparing EBL with other endoscopic modalities, so that our results can be confirmed and our knowledge of this condition expanded.
7 (5.7 – 9.7) 10 (5.8 – 14.5) 0.09
CI, confidence interval; PBRC, packed red blood cell.
ported so far. Although patients can experience mild to moderate abdominal pain immediately following the procedure, this usually can be managed with over-the-counter pain medications taken for a few days in combination with oral proton pump inhibitors. Radiofrequency ablation (RFA) has been reported as a new option therapy for GAVE, with promising results; however, this technique requires additional training and is not available in all endoscopic centers [8, 9]. Potential complications of APC and RFA in-
1 Regula J, Wronska E, Pachlewski J. Vascular lesions of the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2008; 22: 313 – 328 2 Ito M, Uchida Y, Kamano S et al. Clinical comparisons between two subsets of gastric antral vascular ectasia. Gastrointest Endosc 2001; 53: 764 – 770 3 Ripoll C, Garcia-Tsao G. Management of gastropathy and gastric vascular ectasia in portal hypertension. Clin Liver Dis 2010; 14: 281 – 295 4 Swanson E, Mahgoub A, MacDonald R et al. Medical and endoscopic therapies for angiodysplasia and gastric antral vascular ectasia: a systematic review. Clin Gastroenterol Hepatol 2014; 4: 571 – 582 5 Sato T, Yamazaki K, Akaike J. Endoscopic band ligation versus argon plasma coagulation for gastric antral vascular ectasia associated with liver diseases. Dig Endosc 2012; 24: 237 – 242 6 Wells CD, Harrison ME, Gurudu SR et al. Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation. Gastrointest Endosc 2008; 68: 231 – 236 7 Keohane J, Berro W, Harewood GC et al. Band ligation of gastric antral vascular ectasia is a safe and effective endoscopic treatment. Dig Endosc 2013; 25: 392 – 396 8 Gross SA, Al-Haddad M, Gill KR et al. Endoscopic mucosal ablation for the treatment of gastric antral vascular ectasia with the HALO90 system: a pilot study. Gastrointest Endosc 2008; 67: 324 – 327 9 Dray X, Repici A, Gonzalez P et al. Radiofrequency ablation for the treatment of gastric antral vascular ectasia. Endoscopy 2014; 46: 963 – 969
Zepeda-Gómez Sergio et al. Endoscopic band ligation treatment of gastric antral vascular ectasia … Endoscopy 2015; 47: 538–540
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
540
Copyright of Endoscopy is the property of Georg Thieme Verlag Stuttgart and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Gastric antral vascular ectasia: a prospective study of treatment with endoscopic band ligation
Authors
Sergio Zepeda-Gómez1, Richard Sultanian1, Christopher Teshima1, Gurpal Sandha1, Sander Van Zanten1, Aldo J. Montano-Loza2
Institutions
1 2
submitted 12. November 2014 accepted after revision 7. December 2014
Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1391395 Published online: 4.2.2015 Endoscopy 2015; 47: 538–540 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X Corresponding author Sergio Zepeda-Gómez, MD Zeidler Ledcor Centre 130 University Campus University of Alberta Edmonton, Alberta T6G 2X8 Canada Fax: +1-780-492-9416 [email protected]
Division of Gastroenterology, University of Alberta Hospital, Edmonton, Alberta, Canada Division of Hepatology, University of Alberta Hospital, Edmonton, Alberta, Canada
Gastric antral vascular ectasia (GAVE) is characterized by red, angiomatous lesions in the antrum organized either in stripes or in a diffuse pattern that can be associated with upper gastrointestinal bleeding. Endoscopic band ligation (EBL) has been reported as an effective alternative therapy for patients with GAVE. Consecutive patients with a diagnosis of GAVE were prospectively followed while undergoing EBL every 2 months. Hemoglobin, ferritin, and iron levels were frequently recorded, and clinical follow-up was performed. A total of 21 patients with GAVE were enrolled, and 17 of these patients (81 %) had associated co-mor-
bidities, most frequently cirrhosis and chronic renal failure. A clinical response was achieved in 19 patients (91 %). A significant improvement in the mean hemoglobin level was noted after EBL (P < 0.001), and a significant decrease in blood transfusion requirements per month (P = 0.001). No major complications were observed during the study period. The mean follow-up was 10 months. EBL is an effective and safe treatment for GAVE. Randomized, controlled trials comparing EBL with other endoscopic therapies are warranted.
Introduction
Patients and methods
!
!
Gastric antral vascular ectasia (GAVE) is a capillary-type vascular malformation located mainly in the gastric antrum. It is characterized by dilated, tortuous mucosal capillaries, which are often occluded by thrombus, as well as by dilated, tortuous submucosal veins [1]. At endoscopy, GAVE may appear as multiple longitudinal streaks that converge at the pyloric orifice (stripe type) or as multiple erythematous spots (diffuse or granular " Fig. 1). Patients with GAVE can be type) [2] (● asymptomatic or may present with iron deficiency anemia or overt gastrointestinal (GI) bleeding. Multiple endoscopic therapies, including Nd:YAG laser therapy, heater probe, monopolar therapy, and argon plasma coagulation (APC), have been reported for the ablation of GAVE [3]. However, the complication rates for these modalities are high (20 % – 33 %), and rates of failed therapy of up to 14 % have been reported [4]. Endoscopic band ligation (EBL) has been reported as an alternative effective endoscopic therapy, and the rate of complications is low in comparison with those reported for APC in retrospective studies [5 – 7]. Therefore, we decided to evaluate the efficacy of EBL for the treatment of GAVE in a prospective study.
All patients 18 years of age and older who underwent upper GI endoscopy between September 2012 and June 2014 and in whom GAVE-associated GI bleeding or GAVE-related iron deficiency anemia was diagnosed were enrolled in the study after they had given informed consent. Patients were excluded if they had received endoscopic treatment for GAVE in the preceding 3 months. Patients who did not have anemia or who had another possible source of upper GI bleeding were also excluded. This study was approved by the University of Alberta Health Research Ethics Board. Demographic and procedure-related data were prospectively recorded. Outcome measures included clinical response (defined by the eradication or near-eradication of GAVE at endoscopic examination along with stabilization of hemoglobin levels and/or a decrease in blood transfusion requirements) and the occurrence of complications. All procedures were performed by three experienced endoscopists (S. Z.-G., R. S., and G. S.). The diagnosis of GAVE was categorized as either stripe type (prominent raised or flat erythematous stripes radiating from the pylorus to the antrum)
Zepeda-Gómez Sergio et al. Endoscopic band ligation treatment of gastric antral vascular ectasia … Endoscopy 2015; 47: 538–540
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
538
Case series
539
or diffuse type (ectasia appearing as many coalescent, round angiodysplastic lesions). The procedures were performed with a diagnostic gastroscope (GIF-H180/GIF-HQ190; Olympus) and the Saeed Multi-Band Ligator (Cook Medical, Bloomington, Indiana, USA). The bands were applied to abnormal-appearing mucosa in the antrum; the application was started in the lesions adjacent to the pylorus, then continued proximally in the antrum in a helicoidal direction until most of the GAVE areas were covered. The number of bands applied was left to the discretion of the endoscopist. In the case of actively bleeding GAVE, the areas with active bleeding were targeted for banding first. The patients were started on proton pump inhibitor therapy (40 mg of pantoprazole every 24 hours), which was continued for at least 4 weeks after EBL. They were advised to stay on a diet of clear fluids and soft food the first 48 hours after the procedure. A second endoscopic evaluation was performed 6 to 8 weeks after the initial treatment, with subsequent gastroscopic examinations conducted at the same interval until a clinical response was achieved. Hemoglobin levels and iron studies were recorded every 4 weeks for at least 6 months after the initial treatment with EBL.
Statistical analysis Categorical variables were analyzed with Fisher’s exact test and dimensional variables with the Mann–Whitney U test. For the analysis of related samples (e. g., hemoglobin levels before and after treatment), the Wilcoxon signed-rank test was used. A P level below 0.05 was considered statistically significant. Results were expressed as proportion or mean with range or 95 % confidence interval (95 %CI).
Results !
A total of 28 patients were evaluated during the study period. Of these, 7 were excluded for the following reasons: endoscopic treatment for GAVE had been administered to 4 patients within the last 3 months, no evidence of anemia was found in 2 patients,
and another source of upper GI bleeding was found in 1 patient, so 21 patients were included in the final analysis. The complete " Tademographic and baseline characteristics are presented in ● ble 1. A clinical response was achieved in 19 patients (91 %) after a mean of 2.28 (range, 1 – 6) endoscopic sessions. The maximum number of bands applied in a single session was 9. A clinical response was not achieved in 2 patients, who continued to require blood transfusions. These 2 patients had chronic renal failure in association with diffuse-type GAVE and required additional APC and EBL treatment. Moderate to severe diffuse abdominal pain developed in 2 patients immediately after the procedure. One of them was admitted overnight and discharged 24 hours later without pain. Neither required any further interventions. No other complications were observed. A significant improvement in the mean hemoglobin level was noted after the last endoscopic treatment session for GAVE compared with the pretreatment hemoglobin level (P < 0.001). In the 13 patients who were dependent on blood transfusions before treatment, the mean number of packed red blood cell transfusions per month was significantly decreased after eradication in comparison with baseline (P = 0.001). A significant improvement in the serum ferritin levels (P = 0.04) was also noted after eradication, as was a trend toward improvement in the serum iron levels (P = " Table 2). 0.09) (●
Discussion !
We present here the results of the first prospective study in which EBL was used to treat consecutive patients with GI bleeding or anemia due to GAVE. Endoscopic improvement with the use of EBL was achieved in 91 % of the patients. This was associated with significant improvements in the hemoglobin and ferritin levels and a reduction in blood transfusion requirements at follow-up. EBL is a relatively easy technique when used for GAVE therapy and has been shown to be safe, with no major complications re-
Zepeda-Gómez Sergio et al. Endoscopic band ligation treatment of gastric antral vascular ectasia … Endoscopy 2015; 47: 538–540
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Fig. 1 Endoscopic views of gastric antral vascular ectasia (GAVE). a Stripe type. b Diffuse type with areas of active bleeding. c After band ligation. d Nearly complete eradication after two sessions of endoscopic band ligation.
Case series
Table 1 Characteristics of the patients at the time of the first endoscopic band ligation (EBL) treatment for gastric antral vascular ectasia (GAVE). Patients (females:males), n
21 (15:6)
Age, mean ± SD (range), y
65 ± 13 (44 – 87)
Co-morbidities, n (%)
17 (81)
Cirrhosis
8 (38)
Chronic renal failure
5 (24)
Scleroderma
1 (5)
Atrial fibrillation
3 (14)
Clinical presentation, n (%) Iron deficiency anemia Overt gastrointestinal bleeding Previous argon plasma coagulation (APC) treatment, n (%) Blood transfusion-dependent patients, n (%)
13 (62) 8 (38) 9 (43) 13 (62)
GAVE type, n (%) Diffuse
12 (57)
Stripe
9 (43)
SD, standard deviation.
Table 2 Outcomes after endoscopic band ligation (EBL) in 21 patients with gastric antral vascular ectasia (GAVE). Follow-up, mean (range), months Sessions needed for eradication, mean (range), n
10 (2 – 17) 2.28 (1 – 6)
Bands applied, mean (range), n
16 (6 – 59)
Clinical response, n (%)
19 (91)
Hematologic parameters Hemoglobin level, mean (95 %CI), g/L Before EBL After EBL P value
88 (101 – 118) 109 (79 – 97)
References
Before EBL
2.85 (2.03 – 3.6)
After EBL
1.15 (0.3 – 2)
P value
0.001
Ferritin level, mean (95 %CI), μg/L Before EBL P value
63 (17.6 – 96.3) 105 (0.18 – 208) 0.04
Iron level, mean (95 % CI), μmol/L Before EBL After EBL P value
Competing interests: None
< 0.001
Total number of PRBC units per month, mean (95 %CI)
After EBL
clude perforation and bleeding, whereas EBL has been associated only with transient abdominal pain. Many issues need to be clarified to improve the treatment of GAVE with EBL. These include determinations of the optimal interval between treatment sessions, the need for combined therapy with APC or other modalities in patients who have a poor response, and the duration and frequency of endoscopic surveillance to look for recurrence after eradication. Although no comparison was made between the treatment efficacy of EBL and that of APC in this study, perhaps it is instructive that 43 % of the patients had undergone multiple failed endoscopic treatment sessions with APC, and in all but one of these patients, a clinical response was achieved with EBL. Given the reduced number of procedures required to achieve a complete endoscopic response with EBL and the reduction in transfusion requirements, EBL is likely to decrease health care costs for this group of patients. However, a randomized, controlled trial will be needed to determine whether EBL is truly superior to APC as the primary endoscopic therapy for GAVE. In summary, our study suggests that EBL constitutes an effective and safe treatment for GAVE, associated with improved hematologic parameters and decreased blood transfusion requirements. The limitations of our study include a relatively small sample and the lack of comparison with other endoscopic techniques. We believe that our data should encourage further clinical trials comparing EBL with other endoscopic modalities, so that our results can be confirmed and our knowledge of this condition expanded.
7 (5.7 – 9.7) 10 (5.8 – 14.5) 0.09
CI, confidence interval; PBRC, packed red blood cell.
ported so far. Although patients can experience mild to moderate abdominal pain immediately following the procedure, this usually can be managed with over-the-counter pain medications taken for a few days in combination with oral proton pump inhibitors. Radiofrequency ablation (RFA) has been reported as a new option therapy for GAVE, with promising results; however, this technique requires additional training and is not available in all endoscopic centers [8, 9]. Potential complications of APC and RFA in-
1 Regula J, Wronska E, Pachlewski J. Vascular lesions of the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2008; 22: 313 – 328 2 Ito M, Uchida Y, Kamano S et al. Clinical comparisons between two subsets of gastric antral vascular ectasia. Gastrointest Endosc 2001; 53: 764 – 770 3 Ripoll C, Garcia-Tsao G. Management of gastropathy and gastric vascular ectasia in portal hypertension. Clin Liver Dis 2010; 14: 281 – 295 4 Swanson E, Mahgoub A, MacDonald R et al. Medical and endoscopic therapies for angiodysplasia and gastric antral vascular ectasia: a systematic review. Clin Gastroenterol Hepatol 2014; 4: 571 – 582 5 Sato T, Yamazaki K, Akaike J. Endoscopic band ligation versus argon plasma coagulation for gastric antral vascular ectasia associated with liver diseases. Dig Endosc 2012; 24: 237 – 242 6 Wells CD, Harrison ME, Gurudu SR et al. Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation. Gastrointest Endosc 2008; 68: 231 – 236 7 Keohane J, Berro W, Harewood GC et al. Band ligation of gastric antral vascular ectasia is a safe and effective endoscopic treatment. Dig Endosc 2013; 25: 392 – 396 8 Gross SA, Al-Haddad M, Gill KR et al. Endoscopic mucosal ablation for the treatment of gastric antral vascular ectasia with the HALO90 system: a pilot study. Gastrointest Endosc 2008; 67: 324 – 327 9 Dray X, Repici A, Gonzalez P et al. Radiofrequency ablation for the treatment of gastric antral vascular ectasia. Endoscopy 2014; 46: 963 – 969
Zepeda-Gómez Sergio et al. Endoscopic band ligation treatment of gastric antral vascular ectasia … Endoscopy 2015; 47: 538–540
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
540
Copyright of Endoscopy is the property of Georg Thieme Verlag Stuttgart and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
