Is endoscopic band ligation the gold standard for gastric antral vascular ectasia?

Tanţău, Marcel; Crişan, Dana

doi:10.1055/a-1006-2763

Cited by 6 publications

(10 citation statements)

References 20 publications

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“…Theoretically, EBL is thought to have a deeper effect involving the submucosa, leading to fibrosis and potentially longer effects with less recurrence. 8 Nonetheless, as previously mentioned, this meta-analysis is limited by the small number of pooled patients. In addition, our analyses were limited by the different methodologies, reflected with high heterogeneity, and also by the difference in the reported outcomes between studies.…”

Section: Discussionmentioning

confidence: 98%

“…7 However, compared to APC and RFA which only provide superficial mucosal therapy, EBL remains the only modality that involves deep submucosal therapy and is thought to achieve better outcomes. 8 In addition to being safe, EBL requires less endoscopic expertise, is more widely available, and is thought to be cheaper than APC and EBL. 8,9 No meta-analyses have compared the use of APC and EBL for GAVE management.…”

Section: Introductionmentioning

confidence: 99%

“…A recent meta‐analysis on short‐term data showed that RFA has comparable efficacy and tolerability compared to APC and is also effective in cases refractory to APC 7 . However, compared to APC and RFA which only provide superficial mucosal therapy, EBL remains the only modality that involves deep submucosal therapy and is thought to achieve better outcomes 8 . In addition to being safe, EBL requires less endoscopic expertise, is more widely available, and is thought to be cheaper than APC and EBL 8,9 .…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic band ligation compared to thermal therapy for gastric antral vascular ectasia: A systematic review and meta‐analysis

Chalhoub¹,

Umar²,

Groudan³

et al. 2021

UEG Journal

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Background Gastric antral vascular ectasia is an infrequent cause of gastrointestinal-related blood loss manifesting as iron-deficiency anemia or overt gastrointestinal bleeding, and is associated with increased healthcare burdens. Endoscopic therapy of gastric antral vascular ectasia most commonly involves endoscopic thermal therapy. Endoscopic band ligation has been studied as an alternative therapy with promising results in gastric antral vascular ectasia. Aims The primary aim was to compare the efficacy of endoscopic band ligation and endoscopic thermal therapy by argon plasma coagulation for the management of bleeding gastric antral vascular ectasia in terms of the mean post-procedural transfusion requirements and the mean hemoglobin level change. Secondary outcomes included a comparison of the number of sessions needed for cessation of bleeding, the change in transfusion requirements, and the adverse events rate. Methods PubMed, Medline, SCOPUS, Google Scholar, and the Cochrane Controlled Trials Register were reviewed. Randomized controlled clinical trials and retrospective studies comparing endoscopic band ligation and endoscopic thermal therapy in bleeding gastric antral vascular ectasia, with a follow-up period of at least 6 months, were included. Statistical analysis was done using Review Manager. Results Our search yielded 516 papers. After removing duplicates and studies not fitting the criteria of selection, five studies including 207 patients were selected for analysis. Over a follow-up period of at least 6 months, patients treated with endoscopic band ligation had significantly lower post-procedural transfusion requirements (MD −2.10; 95% confidence interval (−2.42 − −1.77)) and a significantly higher change in the mean hemoglobin with endoscopic band ligation vs endoscopic thermal therapy (MD 0.92; 95% confidence interval (0.39 − 1.45)). Endoscopic band ligation led to a fewer number of required sessions (MD −1.15; 95% confidence interval (−2.30 − −0.01)) and a more pronounced change in transfusion requirements (MD −3.26; 95% confidence interval (−4.84 − −1.68)). There was no difference in adverse events. Conclusion Results should be interpreted cautiously due to the limited literature concerning the management of gastric antral vascular ectasia. Compared to endoscopic thermal therapy, endoscopic band ligation for the management of bleeding gastric antral vascular ectasia led to significantly lower transfusion requirements, showed a trend toward more remarkable post-procedural hemoglobin elevation, and a fewer number of procedures. Endoscopic band ligation may improve outcomes and lead to decreased healthcare burden and costs.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic band ligation compared to thermal therapy for gastric antral vascular ectasia: A systematic review and meta‐analysis

Chalhoub¹,

Umar²,

Groudan³

et al. 2021

UEG Journal

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“…Most studies have demonstrated APC and RFA to have an endoscopic success rate from 70 % to 90 % overall 18 . However, while these success rates up to 90 % are impressive with thermal therapy, it is important to highlight that these treatment strategies act mostly upon the mucosal layer, with limited ability to penetrate to the deeper submucosal layer 19 .…”

Section: Introductionmentioning

confidence: 99%

“…Given our current understanding of GAVE, with involvement of both the mucosal and submucosal layer, it stands to reason that treatment techniques designed to act upon both gastrointestinal layers may be a more effective strategy 19 . One such treatment strategy, which is already the mainstay treatment for esophageal varices, is endoscopic band ligation (EBL).…”

Section: Introductionmentioning

confidence: 99%

Endoscopic band ligation in the treatment of gastric antral vascular ectasia: a systematic review and meta-analysis

et al. 2021

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Background and study aims While argon plasma coagulation (APC) is the first-line treatment for gastric antral vascular ectasia (GAVE), endoscopic band ligation (EBL) has shown promising results. The aim of this study was to perform a systematic review and meta-analysis to evaluate the effectiveness of EBL for the treatment of GAVE. Methods Individualized search strategies were developed in accordance with PRISMA and MOOSE guidelines through September 1, 2020. Measured outcomes included endoscopic success (defined as GAVE eradication/improvement), change in hemoglobin, transfusion dependency, number of treatment sessions, adverse events, rebleeding, and bleeding-associated mortality. Outcomes were compared among studies evaluating EBL versus APC. Results Eleven studies (n = 393; 59.39 % female; mean age 58.65 ± 8.85 years) were included. Endoscopic success was achieved in 87.84 % [(95 % CI, 80.25 to 92.78); I2 = 11.96 %] with a mean number of 2.50 ± 0.49 treatment sessions and average of 12.40 ± 3.82 bands applied. For 8 studies comparing EBL (n = 143) versus APC (n = 174), there was no difference in baseline patient characteristics. However, endoscopic success was significantly higher for EBL [OR 6.04 (95 % CI 1.97 to 18.56; P = 0.002], requiring fewer treatment sessions (2.56 ± 0.81 versus 3.78 ± 1.17; P < 0.001). EBL was also associated with a greater increase in post-procedure hemoglobin [mean difference 0.35 (95 % CI 0.07 to 0.62; P = 0.0140], greater reduction in transfusions required [mean difference –1.46 (95 % CI –2.80 to –0.12; P = 0.033], and fewer rebleeding events [OR 0.11 (95 % CI, 0.04 to 0.36); P < 0.001]. There was no difference in adverse events or bleeding-associated mortality (P > 0.050). Conclusions EBL appears to be safe and effective for treatment of GAVE, with improved outcomes when compared to APC.

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Comparisons Between Endoscopic Band Ligation, Radiofrequency Ablation and Endoscopic Thermal Therapy for Gastric Antral Vascular Ectasia: A Meta-Analysis

Che,

Shiu,

et al. 2023

Dig Dis Sci

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Background Endoscopic band ligation (EBL) and radiofrequency ablation (RFA) have emerged as alternative therapies of gastric antral vascular ectasia (GAVE) in addition to endoscopic thermal therapy (ETT), but the optimum choice remains inconclusive. Aim We conducted a meta-analysis in order to compare these three treatments for GAVE. Methods We searched the electronic databases of PubMed, Embase and Cochrane Central Register of Controlled Trials without any language restrictions and also performed a manual literature search of bibliographies located in both retrieved articles and published reviews for eligible publications prior to December 8, 2021. We included comparative trials which had evaluated the efficacy and safety of interventions in adults (aged ≥ 18 years) diagnosed with symptomatic GAVE and was confirmed according to clinical backgrounds and upper gastrointestinal endoscopy. We included reports that compared three interventions, ETT, EBL, and RFA. The study was comprised of adults diagnosed with GAVE and focused on overall mortality, bleeding cessation, endoscopic improvement, complications, hospitalization, hemoglobin improvement, number of sessions and transfusion requirements. Results Twelve studies were performed involving a total of 571 participants for analysis. When compared with ETT, EBL achieved better bleeding cessation (OR 4.48, 95% CI 1.36–14.77, p = 0.01), higher hemoglobin improvement (MD 0.57, 95% CI 0.31–0.83, p < 0.01) and lower number of sessions (MD − 1.44, 95% CI − 2.54 to − 0.34, p = 0.01). Additionally, EBL was superior to ETT in endoscopic improvement (OR 6.00, 95% CI 2.26–15.97, p < 0.01), hospitalization (MD − 1.32, 95% CI − 1.91 to − 0.74, p < 0.01) and transfusion requirement (MD − 2.66, 95% CI − 4.67 to − 0.65, p = 0.01) with statistical significance, with the exception of mortality (OR 0.58, 95% CI 0.19–1.77, p = 0.34) and complication rate (OR 5.33, 95% CI 0.58–48.84, p = 0.14). Conclusion For GAVE, we suggest that EBL be initially recommended, and APC and RFA be used as alternative treatment choices based upon a very low quality of evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s10620-023-08028-7.

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Is endoscopic band ligation the gold standard for gastric antral vascular ectasia?

Cited by 6 publications

References 20 publications

Endoscopic band ligation compared to thermal therapy for gastric antral vascular ectasia: A systematic review and meta‐analysis

Endoscopic band ligation compared to thermal therapy for gastric antral vascular ectasia: A systematic review and meta‐analysis

Endoscopic band ligation in the treatment of gastric antral vascular ectasia: a systematic review and meta-analysis

Comparisons Between Endoscopic Band Ligation, Radiofrequency Ablation and Endoscopic Thermal Therapy for Gastric Antral Vascular Ectasia: A Meta-Analysis

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