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Review
. 2021 Aug 12:12:20406223211039696.
doi: 10.1177/20406223211039696. eCollection 2021.

Endoscopic treatment for gastric antral vascular ectasia

Mengyuan Peng  1 , Xiaozhong Guo  1 , Fangfang Yi  1 , Xiaodong Shao  1 , Le Wang  1 , Yanyan Wu  1 , Chunmei Wang  1 , Menghua Zhu  1 , Ou Bian  2 , Mostafa Ibrahim  3 , Saurabh Chawla  4 , Xingshun Qi  5
Affiliations
Review

Endoscopic treatment for gastric antral vascular ectasia

Mengyuan Peng et al. Ther Adv Chronic Dis. .

Abstract

Gastric antral vascular ectasia (GAVE) is one of the uncommon causes of upper gastrointestinal bleeding. Major treatment of GAVE includes pharmacotherapy, endoscopy, and surgery. The efficacy and safety of pharmacotherapy have not been sufficiently confirmed; and surgery is just considered when conservative treatment is ineffective. By comparison, endoscopy is a common treatment option for GAVE. This paper reviews the currently used endoscopic approaches for GAVE, mainly including argon plasma coagulation (APC), radiofrequency ablation (RFA), and endoscopic band ligation (EBL). It also summarizes their efficacy and procedure-related adverse events. The endoscopic success rate of APC is 40-100%; however, APC needs several treatment sessions, with a high recurrence rate of 10-78.9%. The endoscopic success rates of RFA and EBL are 90-100% and 77.8-100%, respectively; and their recurrence rates are 21.4-33.3% and 8.3-48.1%, respectively. Hyperplastic gastric polyps and sepsis are major adverse events of APC and RFA; and Mallory-Weiss syndrome is occasionally observed after APC. Adverse events of EBL are rare and mild, such as nausea, vomiting, esophageal or abdominal pain, and hyperplastic polyps. APC is often considered as the first-line choice of endoscopic treatment for GAVE. RFA and EBL have been increasingly used as alternatives in patients with refractory GAVE. A high recurrence of GAVE after endoscopic treatment should be fully recognized and cautiously managed by follow-up endoscopy. In future, a head-to-head comparison of different endoscopic approaches for GAVE is warranted.

Keywords: argon plasma coagulation; endoscopic band ligation; gastric antral vascular ectasia; radiofrequency ablation.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Endoscopic images of striped (a) and diffuse (b) GAVE. GAVE, gastric antral vascular ectasia.
Figure 2.
Figure 2.
Outcomes of GAVE patients undergoing APC. Panel a, endoscopic success rate; Panel b, change in blood transfusion requirement; Panel c, recurrence rate; Panel d, incidence of adverse events. APC, argon plasma coagulation; GAVE, gastric antral vascular ectasia.
Figure 3.
Figure 3.
Outcomes of GAVE patients undergoing RFA. Panel a, endoscopic success rate; Panel b, change in blood transfusion requirement; Panel c, recurrence rate; Panel d, incidence of adverse events. GAVE, gastric antral vascular ectasia; RFA, radiofrequency ablation.
Figure 4.
Figure 4.
Outcomes of GAVE patients undergoing EBL. Panel a, endoscopic success rate; Panel b, change in blood transfusion requirement; Panel c, recurrence rate; Panel d, incidence of adverse events. EBL, endoscopic band ligation; GAVE, gastric antral vascular ectasia.
See this image and copyright information in PMC

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