Endotherapeutic approach to gastric antral vascular ectasia: Argon plasma coagulation vs. endoscopic band ligation: Randomized clinical trial

Gastric antral vascular ectasia (GAVE) causes iron-deficiency anemia and gastrointestinal bleeding, sometimes requiring frequent transfusions. Argon plasma coagulation (APC) is effective for treating lesions, but newer methods like endoscopic band ligation (EBL) need to be explored. Conducted at a tertiary referral center in India, this single-blinded, prospective, parallel-group randomized study involved 60 patients assigned (1:1) to APC or EBL for endoscopic GAVE obliteration. The primary outcome was clinical success, defined as lesion obliteration and the number of endoscopic sessions required for lesion obliteration. Secondary outcomes included technical success, rebleeding episodes, GAVE recurrence, and hospitalization or transfusion needs. Registered as CTRI Reg. No. CTRI/2023/10/058739. At 2- and 3-month follow-ups, endoscopic GAVE obliteration was higher in the EBL group (63.3% vs. 30%; P = 0.02 and 86.6% vs. 53.3%; P = 0.01), but similar at 1- and 6-month follow-ups. Rebleeding episodes were fewer in the EBL group during the initial 3 months (13.3% vs. 40%; P = 0.04) but comparable during the subsequent 3 months. Time to rebleeding (weeks) was significantly longer in the EBL group as compared with the APC group (11.6 vs 10.9; P = 0.0006). After 6 months, the EBL group had higher hemoglobin levels (P = 0.01) and required fewer transfusions (P = 0.0001). Survival time was comparable between the groups (P = 0.33). Both EBL and APC effectively treated GAVE lesions and relieved symptoms. Although overall outcomes were similar, EBL required fewer sessions, had less and delayed rebleeding, reduced transfusion needs, and improved hemoglobin levels, indicating higher efficacy in deeper lesion obliteration.