Initial treatment approaches for nodular gastric antral vascular ectasia: A comparison of endoscopic band ligation and thermal therapies.

BACKGROUND: Gastric antral vascular ectasia (GAVE) accounts for up to 4% of nonvariceal upper gastrointestinal bleeding. Argon plasma coagulation and radiofrequency ablation have been primary treatment modalities for patients with linear and punctate subtypes, with a newer trend of utilization of endoscopic band ligation (EBL). This study evaluates the outcomes of patients undergoing treatment for nodular GAVE. We hypothesize that patients treated initially with EBL will achieve higher rates of clinical remission with fewer endoscopic treatments and a shorter treatment interval. AIM: To investigate the effects of EBL as an initial treatment therapy on outcomes associated with nodular GAVE. METHODS: A total of 37 patients at a tertiary medical center with nodular GAVE were included in this retrospective study. The study population was divided between those treated initially with EBL (initial EBL) and initial endoscopic thermal therapy. Pre-treatment and post-treatment hemoglobin values, the model for end-stage liver disease scores, hospitalization rates, and other outcomes. Additionally, endoscopic treatment modality type and frequency were recorded, including radiofrequency ablation, argon plasma coagulation, and EBL. Continuous variables were compared using a t-test, while categorical variables were compared using Fisher's exact. RESULTS: Linear regression analysis displayed a positive relationship between the time interval from initial therapeutic esophagogastroduodenoscopy to first EBL treatment and overall treatment interval (t = 7.39, P < 0.001), as well as between the number of endoscopic treatments (t = 8.09, P < 0.001). Hemoglobin levels increased in both the initial EBL group (8.7 vs 11.4, P < 0.001) and the initial endoscopic thermal therapy group (8.6 vs 10.4, P = 0.042). Clinical remission rates were higher in the initial EBL group (90% vs 69% P = 0.041), with a non-significant trend of higher endoscopic remission rates (57.1% vs 37.5%, P = 0.270). CONCLUSION: The observed trend favoring EBL, combined with its association with improved clinical remission and reduced treatment burden, supports its consideration as a preferred initial treatment approach.