P1477 - Endoscopic Band Ligation in Treatment of Gastric Antral Vascular Ectasia (GAVE): A Systematic Review and Meta-Analysis

Gregory Toy, MD¹, Babu Mohan, MD¹, Lena Kassab, MD, MBA², Douglas Adler, MD^1
1University of Utah School of Medicine, Salt Lake City, UT; ²Mayo Clinic, Rochester, MN

Introduction: Gastric antral vascular ectasia (GAVE) is a vascular malformation primarily seen in the prepyloric gastric antrum. Patients can present with chronic blood loss or more rarely with acute overt gastrointestinal bleeding. The most common endoscopic treatment strategy involves thermal therapy like argon plasma coagulation or radiofrequency ablation. Endoscopic band ligation (EBL) is an alternative treatment but has not gathered momentum despite encouraging outcomes. This meta-analysis was performed to determine pooled rates of clinical outcomes for EBL in the treatment of GAVE.

Methods: A comprehensive search of databases like PUBMED, EMBASE, SCOPUS were conducted and studies were retrieved based on pre-specified inclusion and exclusion criteria. The outcomes assessed were treatment responders, recurrence of GAVE after treatment, sessions of treatment required, pre and post treatment hemoglobin (Hb), pre and post treatment units of packed red blood cells (pRBC) transfused, pre and post treatment length of hospital stay, and adverse events. Meta-analysis was conducted by the random-effects model and heterogeneity was assessed by the I2% statistic and the 95% prediction interval.

Results: The analysis included nine studies and 176 patients. The pooled rate of treatment responders was 81.2% (95% CI 58.2-93.1) and the pooled rate of GAVE recurrence was 13.3% (95% CI 2.3-49.6). The pooled mean sessions of treatment was 2.45 (95% CI 2.12-2.77). The pooled mean Hb difference pre and post procedure was 1.65 (95% CI 0.87-2.43), p=0.001. The pooled mean difference of pre to post treatment units of pRBCs transfused was 1.37 (95% CI 0.54-2.21), p=0.001. The pooled mean difference of pre to post treatment hospitalizations was 0.67 (95% CI 0.19-1.14), p=0.006. The pooled adverse events with EBL treatment for GAVE was 12% (95% CI 7.2-19.5). Heterogeneity was moderate based on the 95% prediction interval (Table 1).

Discussion: The high rate of response with as low as 2 to 3 sessions is a key finding. Statistically significant changes in Hb, pRBC transfusions and hospitalizations establish the efficacy of EBL in treatment of GAVE. Although the pooled adverse events was 12%, none of these events warranted admission or prolonged observation. This meta-analysis demonstrates high response to treatment and excellent treatment outcomes of EBL in patients with GAVE.

Outcomes of endoscopic band ligation in GAVE	Pooled rate (95% confidence interval)	Heterogeneity: 95% Prediction interval, I2%	p-value
Treatment responders	81.2% (58.2-93.1)	73% 11 to 99	--
GAVE recurrence	13.3% (2.3-49.6)	81% 1 to 99	--
Mean sessions of treatment	2.45 (2.12-2.77)	88% 2 to 4	--
Mean pre treatment Hb	8.1 (7.36-8.84)	94% 5 to 11	--
Mean post treatment Hb	10.27 (9.79-10.75)	84% 9 to 12	--
Mean difference of pre and post treatment Hb	1.65 (0.87-2.43) 8 studies	80% -1 to 4	0.001
Mean pre treatment units of PRBC	5.99 (3.48-8.5)	96% -5 to 13	--
Mean post treatment units of PRBC	5.36 (-0.89-11.6)	96% -1 to 3	--
Mean difference of pre and post treatment units of PRBC	1.37 (0.54-2.21) 6 studies	76% -2 to 5	0.001
Mean pre treatment hospital length of stay	1.67 (0.79-2.54)	71% -8 to 11	--
Mean post treatment hospital length of stay	0.6 (-0.11-1.31)	98% -3 to 4	--
Mean difference of pre and post treatment hospital length of stay	0.67 (0.19-1.14) 3 studies	73% -9 to 11	0.006
Adverse events	12% (7.2-19.5)	0% 5 to 25	--
GAVE: gastric antral vascular ectasia, PRBC: packed red blood cells, Hb: hemoglobin.

Table: Summary of pooled rates


Disclosures:
Gregory Toy indicated no relevant financial relationships.
Babu Mohan indicated no relevant financial relationships.
Lena Kassab indicated no relevant financial relationships.
Douglas Adler indicated no relevant financial relationships.


Gregory Toy, MD¹, Babu Mohan, MD¹, Lena Kassab, MD, MBA², Douglas Adler, MD¹. P1477 - Endoscopic Band Ligation in Treatment of Gastric Antral Vascular Ectasia (GAVE): A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.