World Journal of Medical Sciences 10 (3): 357-361, 2014
ISSN 1817-3055
© IDOSI Publications, 2014
DOI: 10.5829/idosi.wjms.2014.10.3.8212
Correspnding Author: Mohammed Salah Abdelbary, Department of Endemic Medicine,
Faculty of Medicine, Cairo University, Egypt.
357
Endoscopic Band Ligation Versus Argon Plasma Coagulation for the
Treatment of Gastric Antral Vascular Ectasia in Egyptian
Patients with Liver Cirrhosis
Hanan Abdelhalim, Ibrahim Mostafa, Mohammed Salah Abdelbary,
1 2 1
Mahmoud Elansary, Mahmoud Abdo and Ali Abdel Rahim
2 1 2
Department of Endemic Medicine, Faculty of Medicine, Cairo University
1
Theodor Bilharz Research Institute (TBRI) Cairo, Egypt
2
Abstract: Argon Plasma Coagulation (APC) is the standard treatment of Gastric antral vascular ectasia (GAVE).
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. Recently, the use
of banding in the gastric antrum with the same system that is used for variceal ligation has been evaluated for
the treatment of GAVE.The aim of this study was to evaluate the therapeutic effects of EBL as a new modality
for the treatment of bleeding from GAVE in comparison to APC in Egyptian patients with liver cirrhosis. The
study was conducted on forty cirrhotic patients presenting with overt or occult bleeding from GAVE. The
patients were divided into two groups: Group I (APC) group: 20 patients were subjected to APC.Group II (EBL)
group: 20 patients were subjected to EBL. Sessions were applied every 3 weeks till adequate endoscopic
ablation was achieved. Regular follow-up and endoscopic assessment at 6 months were done with
documentation of the recurrence of GAVE if that occurred. Results revealed that Twenty one patients were
females and 19 were males with age ranging from 40-70 years old. Most of the patients presented with overt
bleeding (hematemesis and/or melena)(85% In the APC group and 80% in the EBL group).EBL was superior to
APC as regards the rate of cessation of bleeding (95 versus 65%),lower rate of recurrence during follow-up (5
versus 40%) as well as higher increase in hemoglobin(P value 0.179), less transfusion requirements ( P value
<0.01), decreased rate of hospitalization (P value 0.045) and fewer treatment sessions (p value 0.001). In
conclusions, Both APC and EBL are effective treatment options for GAVE. However, EBL proved to be superior
to APC.
Key words: Liver Cirrhosis Gastric Antral Vascular Ectasia Argon Plasma Coagulation Endoscopic Band
Ligation
INTRODUCTION The endoscopic treatment of GAVE with thermal
Gastric Antral Vascular Ectasia (GAVE) is coagulation (APC) has been successful and provided
characterized by the presence of red spots without a an alternative to surgical antrectomy, but significant
background mosaic pattern that are typically located in limitations including multiple treatment sessions,
the gastric antrum. GAVE is most frequently observed persistent bleeding and occasionally complications remain
in patients with cirrhosis and portal hypertension. The [3, 4].
etiology of this disorder remains unknown but recent Endoscopic band ligation (EBL) has become the
theories include hypergastrenemia and elevated antral standard treatment of varices because it effectively
motility [1, 2]. obliterates the submucosal plexus of esophageal varices
therapies such as laser, electrocautery and argon plasma