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INTRODUCTIONGastric antral vascular ectasia (GAVE) is a condition characterized by vascular lesions usually located in the antrum, typically leading to occult or overt bleeding. It accounts for up to 4% of all non-variceal upper gastrointestinal bleeding and can be present in 6-14% of patients with cirrhosis. 1,2 Patients commonly present with chronic iron deficiency anemia, and up to 62% of patients can become transfusion-dependent. 3 Diagnosis is usually established using esophagogastroduodenoscopy (EGD); however, ambiguous cases require histologic assessment. [4][5][6] Endoscopically, it may present with three different patterns: stripes radiating to the pylorus (classically called "watermelon stomach, " more common in non-cirrhotic patients), diffuse punctate lesions (more common in cirrhotic patients), and a nodular type. 7,8 Pharmacological therapies have been shown to have limited benefit. 9-12 Antrectomy has a higher morbidity and mortality. 5

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field, to standardize how to conduct, and to assist in the reasoning and decision-making of doctors. The information provided by this project must be critically evaluated by the physician responsible for the conduct that will be adopted depending on the conditions and the clinical condition of each patient. Guideline conclusion: April 2021. Societies: Sociedade Brasileira de Endoscopia Digestiva.

Background and study aims While endoscopic-guided placement (EGP) of a post-pyloric nasoenteral feeding tube may improve caloric intake and reduce the risk of bronchoaspiration, an electromagnetic-guided placement (EMGP) method may obviate the need for endoscopic procedures. Therefore, the primary aim of this study was to perform a systematic review and meta-analysis of randomized trials comparing the efficacy and safety of EMGP versus EGP of a post-pyloric feeding tube. Methods Protocolized searches were performed from the inception through January 2021 following PRISMA guidelines. Only randomized controlled trials were included comparing EMGP versus EGP. Study outcomes included: technical success (defined as appropriate post-pyloric positioning), tube and patient associated adverse events (AEs), time to enteral nutrition, procedure-associated cost, and procedure time. Pooled risk difference (RD) and mean difference (MD) were calculated using a fixed-effects model and heterogeneity evaluated using Higgins test (I2). Results Four randomized trials (n = 536) were included. A total of 287 patients were included in the EMGP group and 249 patients in the EGP group. There was no difference between EMGP versus EGP regarding technical success, tube-related AEs, patient-related AEs, procedure time, and time in the right position. Time to enteral nutrition favored EMGP (MD: –134.37 [–162.13, –106.61]; I2 = 35 %); with significantly decreased associated cost (MD: –127.77 ($) [–135.8–119.73]; I2 = 0 %). Conclusions Based on this study, EMGP and EGP were associated with similar levels of technical success and safety as well as time to complete the procedure. Despite this, EMGP was associated with reduced cost and time to initiation of nutrition.