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

Christopher D. Wells, M. Edwyn Harrison, Suryakanth R. Gurudu, Michael D. Crowell, Thomas J. Byrne, Giovanni DePetris, Virender K. Sharma

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Background: Gastric antral vascular ectasia (GAVE) is characterized 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 GI 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 center. Intervention: EBL or ETT with argon plasma coagulation or electrocautery. Main Outcome and Measurements: Number of treatments to cessation of bleeding and posttreatment hemoglobin, hospitalization, and transfusion requirement. Results: There were no significant differences in the demographics, clinical presentation, associated portal hypertension, or mean hemoglobin values or the mean number of transfusions or hospitalizations between the 2 groups before treatment. Four patients in the EBL group had failed prior ETT. Compared with ETT, in exploratory statistical testing EBL had a significantly higher rate of bleeding cessation (67% vs 23%, P = .04), fewer treatment sessions required for cessation 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 EBL 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 hospitalizations and transfusion requirements, and allowed for a significant increase in hemoglobin values.

Original languageEnglish (US)
Pages (from-to)231-236
Number of pages6
JournalGastrointestinal Endoscopy
Volume68
Issue number2
DOIs
StatePublished - Aug 2008

Fingerprint

Gastric Antral Vascular Ectasia
Ligation
Hemorrhage
Hot Temperature
Therapeutics
Hemoglobins
Hospitalization
Blood Vessels
Pathologic Dilatations
Argon Plasma Coagulation
Submucous Plexus
Gastric Stump
Withholding Treatment
Electrocoagulation
Esophageal and Gastric Varices

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Wells, C. D., Harrison, M. E., Gurudu, S. R., Crowell, M. D., Byrne, T. J., DePetris, G., & Sharma, V. K. (2008). Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation. Gastrointestinal Endoscopy, 68(2), 231-236. https://doi.org/10.1016/j.gie.2008.02.021

Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation. / Wells, Christopher D.; Harrison, M. Edwyn; Gurudu, Suryakanth R.; Crowell, Michael D.; Byrne, Thomas J.; DePetris, Giovanni; Sharma, Virender K.

In: Gastrointestinal Endoscopy, Vol. 68, No. 2, 08.2008, p. 231-236.

Research output: Contribution to journalArticle

Wells, CD, Harrison, ME, Gurudu, SR, Crowell, MD, Byrne, TJ, DePetris, G & Sharma, VK 2008, 'Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation', Gastrointestinal Endoscopy, vol. 68, no. 2, pp. 231-236. https://doi.org/10.1016/j.gie.2008.02.021
Wells, Christopher D. ; Harrison, M. Edwyn ; Gurudu, Suryakanth R. ; Crowell, Michael D. ; Byrne, Thomas J. ; DePetris, Giovanni ; Sharma, Virender K. / Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation. In: Gastrointestinal Endoscopy. 2008 ; Vol. 68, No. 2. pp. 231-236.
@article{885e494d77174e6ca082e2ccfc581470,
title = "Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation",
abstract = "Background: Gastric antral vascular ectasia (GAVE) is characterized 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 GI 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 center. Intervention: EBL or ETT with argon plasma coagulation or electrocautery. Main Outcome and Measurements: Number of treatments to cessation of bleeding and posttreatment hemoglobin, hospitalization, and transfusion requirement. Results: There were no significant differences in the demographics, clinical presentation, associated portal hypertension, or mean hemoglobin values or the mean number of transfusions or hospitalizations between the 2 groups before treatment. Four patients in the EBL group had failed prior ETT. Compared with ETT, in exploratory statistical testing EBL had a significantly higher rate of bleeding cessation (67{\%} vs 23{\%}, P = .04), fewer treatment sessions required for cessation 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 EBL 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 hospitalizations and transfusion requirements, and allowed for a significant increase in hemoglobin values.",
author = "Wells, {Christopher D.} and Harrison, {M. Edwyn} and Gurudu, {Suryakanth R.} and Crowell, {Michael D.} and Byrne, {Thomas J.} and Giovanni DePetris and Sharma, {Virender K.}",
year = "2008",
month = "8",
doi = "10.1016/j.gie.2008.02.021",
language = "English (US)",
volume = "68",
pages = "231--236",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation

AU - Wells, Christopher D.

AU - Harrison, M. Edwyn

AU - Gurudu, Suryakanth R.

AU - Crowell, Michael D.

AU - Byrne, Thomas J.

AU - DePetris, Giovanni

AU - Sharma, Virender K.

PY - 2008/8

Y1 - 2008/8

N2 - Background: Gastric antral vascular ectasia (GAVE) is characterized 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 GI 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 center. Intervention: EBL or ETT with argon plasma coagulation or electrocautery. Main Outcome and Measurements: Number of treatments to cessation of bleeding and posttreatment hemoglobin, hospitalization, and transfusion requirement. Results: There were no significant differences in the demographics, clinical presentation, associated portal hypertension, or mean hemoglobin values or the mean number of transfusions or hospitalizations between the 2 groups before treatment. Four patients in the EBL group had failed prior ETT. Compared with ETT, in exploratory statistical testing EBL had a significantly higher rate of bleeding cessation (67% vs 23%, P = .04), fewer treatment sessions required for cessation 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 EBL 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 hospitalizations and transfusion requirements, and allowed for a significant increase in hemoglobin values.

AB - Background: Gastric antral vascular ectasia (GAVE) is characterized 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 GI 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 center. Intervention: EBL or ETT with argon plasma coagulation or electrocautery. Main Outcome and Measurements: Number of treatments to cessation of bleeding and posttreatment hemoglobin, hospitalization, and transfusion requirement. Results: There were no significant differences in the demographics, clinical presentation, associated portal hypertension, or mean hemoglobin values or the mean number of transfusions or hospitalizations between the 2 groups before treatment. Four patients in the EBL group had failed prior ETT. Compared with ETT, in exploratory statistical testing EBL had a significantly higher rate of bleeding cessation (67% vs 23%, P = .04), fewer treatment sessions required for cessation 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 EBL 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 hospitalizations and transfusion requirements, and allowed for a significant increase in hemoglobin values.

UR - http://www.scopus.com/inward/record.url?scp=47549093340&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=47549093340&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2008.02.021

DO - 10.1016/j.gie.2008.02.021

M3 - Article

C2 - 18533150

AN - SCOPUS:47549093340

VL - 68

SP - 231

EP - 236

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 2

ER -