From the Guidelines
The recommended treatment for Gastric Antral Vascular Ectasia (GAVE) is endoscopic band ligation (EBL), as it has been shown to lead to decreased blood loss and reduced red blood cell transfusion requirements, with a more pronounced improvement in hemoglobin levels compared to other endoscopic thermal methods 1.
Key Considerations
- EBL is preferred over other endoscopic thermal methods such as argon plasma coagulation or radiofrequency ablation due to its higher efficacy in reducing transfusion requirements and improving hemoglobin levels 1.
- All patients with iron-deficiency anemia and GAVE should receive iron repletion, which may be oral or intravenous depending on the severity of iron depletion and tolerance 1.
- Endoscopic therapy with EBL or thermal methods such as argon plasma coagulation should be considered in individuals with iron-deficiency anemia secondary to GAVE who have an inadequate response to iron replacement 1.
Treatment Approach
- EBL is typically performed during upper endoscopy sessions, with the goal of achieving obliteration of GAVE and reducing transfusion requirements.
- The number of endoscopic sessions required to achieve obliteration of GAVE may vary, but EBL has been shown to require fewer sessions compared to other endoscopic thermal methods 1.
- Regular follow-up endoscopies are important to monitor treatment response and detect any recurrence.
From the Research
Gastric Antral Vascular Ectasia (GAVE) Treatment
The recommended treatment for Gastric Antral Vascular Ectasia (GAVE) includes:
- Pharmacotherapy
- Endoscopy
- Surgery
Endoscopic Treatment Options
Endoscopic treatment options for GAVE include:
- Argon plasma coagulation (APC) 2, 3, 4, 5
- Radiofrequency ablation (RFA) 2, 4
- Endoscopic band ligation (EBL) 2, 3, 6
Efficacy and Safety of Endoscopic Treatment Options
The efficacy and safety of endoscopic treatment options for GAVE are:
- APC: endoscopic success rate of 40-100%, but requires several treatment sessions and has a high recurrence rate of 10-78.9% 2
- RFA: endoscopic success rates of 90-100%, with a recurrence rate of 21.4-33.3% 2, 4
- EBL: endoscopic success rates of 77.8-100%, with a recurrence rate of 8.3-48.1% and fewer adverse events compared to APC 2, 3, 6
Comparison of Endoscopic Treatment Options
Comparing endoscopic treatment options for GAVE:
- EBL appears to be safe and effective, with improved outcomes compared to APC, including higher endoscopic success rates, fewer treatment sessions, and greater reduction in transfusions required 3, 6
- RFA has been shown to be effective in treating refractory GAVE, with a high success rate and low recurrence rate 4