Clin Endosc.  2021 Sep;54(5):669-677. 10.5946/ce.2021.063.

Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

• Hirsch BS
• Ribeiro IB
• Funari MP
• de Moura DTH
• Matuguma SE
• Sánchez-Luna SA
• Mancini FC
• de Oliveira GHP
• Bernardo WM
• de Moura EGH

• KMID: 2520549
• DOI: http://doi.org/10.5946/ce.2021.063

Abstract

Background/Aims
Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for gastric antral vascular ectasia (GAVE). Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility, efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review that included only randomized controlled trials (RCTs) on this topic.
Methods
A comprehensive search was performed using electronic databases to identify RCTs comparing APC and EBL for the treatment of GAVE following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
Results
Four RCTs were included, with a total of 204 patients. EBL was related to higher endoscopic eradication rates risk difference [RD], 0.29; 95% confidence interval [CI] [0.14, 0.44]; I²=0%) and less bleeding recurrence than APC (RD, 0.29; 95% CI [0.15, 0.44]; I²=0%). Patients treated with EBL required fewer blood transfusions (mean difference [MD], 1.49; 95% CI [0.28, 2.71]; I²=96%) and hospitalizations (MD, 0.29; 95% CI [0.19, 0.39]; I²=0%). The number of sessions required for the obliteration of lesions was higher with APC. There was no difference in the incidence of adverse events.
Conclusions
EBL is superior to APC in the treatment of GAVE in terms of endoscopic eradication rates, recurrence of bleeding, and transfusion requirements.

Keyword

Argon plasma coagulation; Endoscopic band ligation; Endoscopy; Gastric antral vascular ectasia

Figure

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  Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-analyses PRISMA flow diagram.

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  Fig. 2. Endoscopic eradication. APC, argon plasma coagulation; CI, confidence interval; EBL, endoscopic band ligation; M-H, Mantel-Haenszel test.

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  Fig. 3. Recurrence of bleeding. APC, argon plasma coagulation; CI, confidence interval; EBL, endoscopic band ligation; M-H, Mantel-Haenszel test.

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  Fig. 4. Transfusion requirement. APC, argon plasma coagulation; CI, confidence interval; EBL, endoscopic band ligation; IV, inverse variance; SD, standard deviation.

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  Fig. 5. Number of sessions. APC, argon plasma coagulation; CI, confidence interval; EBL, endoscopic band ligation; IV, inverse variance; SD, standard deviation.

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  Fig. 6. Number of hospitalizations. APC, argon plasma coagulation; CI, confidence interval; EBL, endoscopic band ligation; IV, inverse variance; SD, standard deviation.

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  Fig. 7. Adverse events. APC, argon plasma coagulation; CI, confidence interval; EBL, endoscopic band ligation; M-H, Mantel-Haenszel test.

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  Fig. 8. (A) Mucosa with gastric antral vascular ectasia. (B) Treatment with argon plasma coagulation. (C) Treatment with endoscopic band ligation.

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