Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation

Background: Gastric antral vascular ectasia (GAVE) is characterised by mucosal and submucosal vascular ectasia causing recurrent GI hemorrhage. Treatment of Gave with endoscopic thermal therapy (ETT) requires multiple sessions for destruction of vascular ectasia and control of bleeding. Endoscopic band ligation (EBL) has become the standard treatment of varices because it effectively obliterates the submucosal plexus of esophageal varices with an acceptably low rate of complications. Additionally, EBL has been used for control of bleeding from other G1 vascular lesions. In patients with GAVE and recurrent GI hemorrhage, EBL may offer an alternative to ETT for treatment of large areas of diseased mucosa and submucosa. Objective: Our purpose was to compare EBL (n = 9) with ETT (n = 13) for the treatment of bleeding from GAVE. Design: Observational comparative study. Patients: Patients with gastric antral vascular ectasia with occult or overt bleeding. Setting: Mayo Clinic Arizona, a multispeciality academic medical centre. Intervention: EBL or ETT with argon plasma coagulation or electrocautery. Main Outcome and Measurements: Number of treatments to cessation of bleeding and posttreatment hemoglobin values or the mean number of transfusions or hospitalisatons between the 2 groups testing EBL had a significantly higher rate of bleeding (1.9 vs 4.7, P = .05), a greater increase in hemoglobin values (2.8g/dL vs 0.9g/dL, P = .05), a greater decrease in transfusion requirements (-12.7 vs -5.2, P = .02), and a greater decrease in hospital admissions (-2.6 vs -0.5, P = .02) during the follow-up period. Analysis of covariance showed significantly superior efficacy of EBL for cessation of bleeding, postprocedure transfusion, and hospitalization. One patient in the EBI, group had postprocedure emesis and 1 in the ETT group had immediate post procedure bleeding. All patients in the EBL group had complete mucosal healing with minimal residual GAVE at follow-up endoscopy failed post-EBL. Conclusions: Our initial experience suggests that EBL is superior to ETT for the management of GAVE. EBL required fewer treatment sessions for control of bleeding, had higher rates for cessation of bleeding, had a reduction in hospitalisation and transfusion requirements, and allowed for a significant increase in hemoglobin values.