Post written by Babu P. Mohan, MD, from the Department of Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, Utah, USA.
Treatment of GAVE is traditionally done by endoscopic thermal therapy like argon plasma coagulation (APC) or radiofrequency ablation (RFA). However, recently, endoscopic band ligation has been reported as an alternative treatment option with good results. The focus of this study was to report the pooled treatment outcomes of endoscopic band ligation in the treatment of GAVE.
Data on the treatment outcomes of endoscopic band ligation in GAVE are currently limited to retrospective studies and single-center prospective studies. This study adds important quality evidence to the literature owing to the reported pooled outcomes by means of meta-analysis.
Based on the analysis of 10 studies, the pooled rate of treatment responders with band ligation in GAVE were 81%, with a pooled recurrence rate of 15.4%. A pooled mean treatment session of 2.4 was required, and the number of bands to achieve eradication per patient was 15.1. Statistically significant mean differences (pre-treatment to post-treatment) were noted with change in Hb, units of PRBCs transfused, and hospital length of stay, establishing excellent clinical outcomes of band ligation in treatment of GAVE. However, this study does not establish the role of band ligation in comparison to other endoscopic thermal therapies; therefore, future well-designed comparative clinical trials are warranted.
One important theoretical consideration is that APC and RFA can be unpredictable as to the extent of treatment depth, whereas band ligation has minimal potential to variability and severs blood supply at the level of submucosa that might be better suited given the submucosal nature of GAVE.
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