Clinical Endoscopy

Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Bruno Salomão Hirsch, Igor Braga Ribeiro, Mateus Pereira Funari, Diogo Turiani Hourneaux de Moura, Sergio Eiji Matuguma, Sergio A. Sánchez-Luna, Fabio Catache Mancini, Guilherme Henrique Peixoto de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(5):669-677. Published online May 31, 2021; DOI: https://doi.org/10.5946/ce.2021.063

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Background
/Aims: Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for gastric antral vascular ectasia (GAVE). Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility, efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review that included only randomized controlled trials (RCTs) on this topic.
Methods
A comprehensive search was performed using electronic databases to identify RCTs comparing APC and EBL for the treatment of GAVE following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
Results
Four RCTs were included, with a total of 204 patients. EBL was related to higher endoscopic eradication rates risk difference [RD], 0.29; 95% confidence interval [CI] [0.14, 0.44]; I²=0%) and less bleeding recurrence than APC (RD, 0.29; 95% CI [0.15, 0.44]; I²=0%). Patients treated with EBL required fewer blood transfusions (mean difference [MD], 1.49; 95% CI [0.28, 2.71]; I²=96%) and hospitalizations (MD, 0.29; 95% CI [0.19, 0.39]; I²=0%). The number of sessions required for the obliteration of lesions was higher with APC. There was no difference in the incidence of adverse events.
Conclusions
EBL is superior to APC in the treatment of GAVE in terms of endoscopic eradication rates, recurrence of bleeding, and transfusion requirements.

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Management of gastrointestinal bleed in the intensive care setting, an updated literature review
Vignesh K Nagesh, Sai Priyanka Pulipaka, Ruchi Bhuju, Emelyn Martinez, Shruthi Badam, Gomathy Aarthy Nageswaran, Hadrian Hoang-Vu Tran, Daniel Elias, Charlene Mansour, Jaber Musalli, Sanket Bhattarai, Lokeash Subramani Shobana, Tannishtha Sethi, Ritvik Se
World Journal of Critical Care Medicine.2025;[Epub] CrossRef
A case report of gastric antral vascular ectasia treated by endoscopic band ligation combined with lauromacrogol injection
Linbo Chen, Keke Sun, Yukai Chen, Pingping Hu, Qi Lin
Medicine.2025; 104(4): e41235. CrossRef
Safety and efficacy of endoscopic band ligation versus argon plasma coagulation in management of gastric antral vascular ectasia: randomized clinical trial
Esraa Y. M. Swifee, Osman A. Osman, Mohamed O Abdel-Malek, Mohamed A Mekky
The Egyptian Journal of Internal Medicine.2025;[Epub] CrossRef
Role of Endoscopy in the Diagnosis, Grading, and Treatment of Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia
Ali Khalifa, Don C. Rockey
Gastrointestinal Endoscopy Clinics of North America.2024; 34(2): 263. CrossRef
Review article: Upper gastrointestinal bleeding – review of current evidence and implications for management
Dennis L. Shung, Loren Laine
Alimentary Pharmacology & Therapeutics.2024; 59(9): 1062. CrossRef
A delayed gastric antral vascular ectasia: A case report and literature review
Zheke Fang, Jiajie Zhu, Zheng Fang, Qiang Hu, Liangjun Yang
Medicine.2024; 103(52): e40831. CrossRef
Bevacizumab in combination with octreotide rescues a patient with liver cirrhosis, GAVE syndrome and refractory hemorrhage – a case report
Simon Johannes Gairing, Eva Maria Schleicher, Lukas Müller, Christian Labenz, Felix Darstein, Daniel Grimm, Visvakanth Sivanathan, Arndt Weinmann, Marcus-Alexander Wörns, Roman Kloeckner, Michael B. Pitton, Florian Thieringer, Khan Fareed Rahman, Peter Ro
Zeitschrift für Gastroenterologie.2023; 61(03): 275. CrossRef
A Practical Approach to the Management of Gastric Antral Vascular Ectasia
Matthew H. Meyers, Laura Rodriguez, Michael S. Kriss
American Journal of Gastroenterology.2023; 118(9): 1532. CrossRef
Endoscopic Advances in Hepatology
Emma Vanderschueren, Jonel Trebicka, Wim Laleman
Seminars in Liver Disease.2023; 43(02): 176. CrossRef
Comparisons Between Endoscopic Band Ligation, Radiofrequency Ablation and Endoscopic Thermal Therapy for Gastric Antral Vascular Ectasia: A Meta-Analysis
Cheng-Che Che, Sz-Iuan Shiu, Chung-Wang Ko, Yu-Kang Tu, Chung-Hsin Chang
Digestive Diseases and Sciences.2023; 68(9): 3534. CrossRef
An update on the management of non-variceal upper gastrointestinal bleeding
Ali A Alali, Alan N Barkun
Gastroenterology Report.2022;[Epub] CrossRef
Endoscopic band ligation in the treatment of gastric antral vascular ectasia: a systematic review and meta-analysis
Babu P. Mohan, Gregory Toy, Lena L. Kassab, Suresh Ponnada, Saurabh Chandan, Sheeva Parbhu, Shaun Chandna, Douglas G. Adler
Gastrointestinal Endoscopy.2021; 94(6): 1021. CrossRef

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Is Endoscopic Band Ligation a Superior Treatment Modality for Gastric Antral Vascular Ectasia Compared to Argon Plasma Coagulation?: Neil Robert O’Morain, Helen O’Donovan, Caroline Conlon, Eileen Shannon, Diarmuid Manning, Eoin Slattery; Clin Endosc 2021;54(4):548-554. Published online January 13, 2021; DOI: https://doi.org/10.5946/ce.2020.236

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Background
/Aims: Gastric antral vascular ectasia (GAVE) is a rare acquired vascular lesion of the gastric antrum. The most frequent presentation of GAVE is iron deficiency anemia. Endoscopic therapy is the mainstay of treatment. However, there is no consensus regarding the optimal treatment modality.
Methods
A retrospective cohort study was performed on patients with GAVE, including patients receiving endoscopic therapy. Treatment was with either argon plasma coagulation (APC) or endoscopic band ligation (EBL). Basic demographic data, indication for index procedure, number of sessions, and pre- and post-hemoglobin levels were collected. The aim of the study was to compare outcomes across the two treatment modalities.
Results
One hundred and seventeen diagnoses of GAVE were made. Sixty-two patients (53%) required endoscopic treatment for symptomatic GAVE (female, n=38, 61%; mean age of 74.4 years). Two hundred and eighteen procedures were performed during the study period. APC was performed (n=161, 74%) more frequently than EBL (n=57, 26%). Patients treated with APC at index required a median 5 subsequent therapeutic interventions (APC or EBL), while those treated with EBL at index required a further 2.9 treatments (EBL only) (p<0.05).
Conclusions
APC was the most common treatment modality employed. We demonstrate an increasing incidence of EBL. Patients treated with EBL at index treatment required fewer subsequent treatment sessions and had a greater mean rise in hemoglobin. This suggests a more effective endoscopic response with EBL.

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A case report of gastric antral vascular ectasia treated by endoscopic band ligation combined with lauromacrogol injection
Linbo Chen, Keke Sun, Yukai Chen, Pingping Hu, Qi Lin
Medicine.2025; 104(4): e41235. CrossRef
Role of Endoscopy in the Diagnosis, Grading, and Treatment of Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia
Ali Khalifa, Don C. Rockey
Gastrointestinal Endoscopy Clinics of North America.2024; 34(2): 263. CrossRef
Comparing Endoscopic Treatment Modalities for Gastric Antral Vascular Ectasia
Manesh Kumar Gangwani, Hossein Haghbin, Fariha Hasan, Julia Dillard, Fouad Jaber, Dushyant Singh Dahiya, Hassam Ali, Faisal Kamal, Umar Hayat, Wade Lee-Smith, Amir Sohail, Sumant Inamdar, Muhammad Aziz, Douglas G. Adler
Journal of Clinical Gastroenterology.2024;[Epub] CrossRef
Snare-tip spray spark coagulation technique for bleeding secondary to gastric antral vascular ectasia
Koudai Hamaguchi, Tatsuma Nomura, Keiichi Ito, Makoto Kobayashi
Endoscopy.2022; 54(10): E562. CrossRef
Gastric Antral Vascular Ectasia (GAVE) a case report, review of the literature and update of techniques
L. Fortuna, A. Bottari, D. Bisogni, F. Coratti, F. Giudici, B. Orlandini, G. Dragoni, F. Cianchi, F. Staderini
International Journal of Surgery Case Reports.2022; 98: 107474. CrossRef
Endoscopic band ligation in the treatment of gastric antral vascular ectasia: a systematic review and meta-analysis
Babu P. Mohan, Gregory Toy, Lena L. Kassab, Suresh Ponnada, Saurabh Chandan, Sheeva Parbhu, Shaun Chandna, Douglas G. Adler
Gastrointestinal Endoscopy.2021; 94(6): 1021. CrossRef

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Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping: Keunmo Kim, Eun Bee Kim, Yong Hyeok Choi, Youngmin Oh, Joung-Ho Han, Seon Mee Park; Clin Endosc 2017;50(2):202-205. Published online September 13, 2016; DOI: https://doi.org/10.5946/ce.2016.112

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Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP). We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL) and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm ovalshaped perforation was found at the lateral duodenal wall. We repaired the perforation by sequentially performing double EBL and endoclipping. The first EBL was performed at the proximal edge of the perforation orifice, and two-thirds of the perforation were repaired. The second EBL, which also included the contents covered under the first EBL, repaired the defect almost completely. Finally, to account for the possible presence of a residual perforation, an endoclip was applied at the distal end of the perforation. The detection and closure of the perforation were completed within 10 minutes. We suggest that double EBL is an effective method for closure.

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Endoscopic treatment of ERCP-related duodenal perforation
Nicole Evans, James L. Buxbaum
Techniques in Gastrointestinal Endoscopy.2019; 21(2): 83. CrossRef

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Endoluminal Closure of Colon Perforation with Endoscopic Band Ligation: Technical Feasibility and Safety in an In Vivo Canine Model: Joung-Ho Han, Myounghwan Kim, Tae Hoon Lee, Hyun Kim, Yunho Jung, Seon Mee Park, Heebok Chae, Seijin Youn, Ji Yun Shin, In-Kwang Lee, Tae Soo Lee, Seok Hwa Choi; Clin Endosc 2015;48(6):534-541. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.534

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Background
/Aims: Endoscopic band ligation (EBL) is an accepted method in the management of variceal bleeding; however, there is little evidence on the safety and feasibility of EBL for the closure of bowel perforation. In this study, we aimed to evaluate the technical feasibility and efficacy of EBL in iatrogenic colon perforation by using a canine model.
Methods
We established an iatrogenic colon perforation model by using seven beagle dogs. Longitudinal 1.5- to 1.7-cm colon perforations were created with a needle knife and an insulated-tip knife, and the perforation was subsequently closed with EBL. During a 2-week follow-up period, the animals were carefully monitored and then euthanized for pathologic examination.
Results
The EBL of iatrogenic colon perforations was successful in all dogs. The mean procedure time for EBL closure with one to three bands was 191.7 seconds, and there were no immediate complications. One animal was euthanized after 3 days because of peritonitis. There were no clinical and laboratory features of sepsis or peritonitis in the remaining six animals. On necropsy, we did not find any fecal peritonitis, pericolonic abscess formation, or transmural dehiscence at the perforation site. Histopathology demonstrated inflamed granulation tissue and scar lesions replaced by fibrosis.
Conclusions
EBL might be a feasible and safe method for the management of iatrogenic colon perforations in an in vivo model.

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Citations to this article as recorded by

Endoscopic Management of Iatrogenic Colon Perforation
Yunho Jung
Clinical Endoscopy.2020; 53(1): 29. CrossRef
Endoluminal closure of an unrecognized penetrating stab wound of the duodenum with endoscopic band ligation: A case report
Dae Hoon Kim, Hanlim Choi, Ki Bae Kim, Hyo Yung Yun, Joung-Ho Han
World Journal of Clinical Cases.2019; 7(20): 3271. CrossRef
Endoscopic management of iatrogenic gastrointestinal perforations
Kan Wang, Jihao Shi, Linna Ye
Laparoscopic, Endoscopic and Robotic Surgery.2019; 2(2): 41. CrossRef
Endoscopic Band Ligation Is Able to Close Perforations Caused by Colonoscopy: A Porcine Model Study
Yidong Yang, Xianyi Lin, Siwei Tan, Xiaoli Huang, Zijun Xie, Xuan Xu, Yiming Lei, Bin Wu
Gastroenterology Research and Practice.2018; 2018: 1. CrossRef

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Intramural Hematoma of the Esophagus after Endoscopic Pinch Biopsy and Endoscopic Band Ligation: Jae Nam Yang, M.D., Yun Jeong Lim, M.D., Ji Hun Kang, M.D., Hyoun Woo Kang, M.D., Jun Kyu Lee, M.D., Yong Seok Lee, M.D.*, Jong Sun Choi, M.D.^† and Jin Ho Lee, M.D.; Korean J Gastrointest Endosc 2010;40(2):107-110. Published online February 27, 2010

Abstract PDF: Esophageal intramural hematoma (EIH) is an uncommon clinical entity among the acute esophageal injuries, and EIH predominantly occurs in middle-aged women. The pathogenesis of EIH has not been clarified, yet this. Seems to occur within the submucosal layer of the esophagus after dissection of the mucosa. EIH may occur spontaneously or secondary to trauma. Patients usually complain of a sudden onset of severe retrosternal chest pain, hematemesis, back pain or dysphagia. Most EIHs show improvement through conservative management, including fasting and intravenous hydration, and this usually completely recovers within a period of 2∼3 weeks. We report here on a case that EIH occurred after endoscopic pinch biopsy and endoscopic band ligation and this EIH was exacerbated in a patient who was taking long-term aspirin medication. (Korean J Gastrointest Endosc 2010;40: 107-110)

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Endoscopic Treatment with Band Ligation and Electrocoagulation for Non-Variceal, Non-Ulcer Upper Gastrointestinal Bleeding: Hwa Min Kim, M.D., Yang Suh Ku, M.D., Moon Gi Chung, M.D., Young Nam Kim, M.D., Do Yoon Lim, M.D., Kwang An Kwon, M.D., Dong Kyun Park, M.D., Sun Suk Kim, M.D., Yeon Suk Kim, M.D., So Young Kwon, M.D., Yu Kyung Kim, M.D., Duck Joo Choi, M.D. and Ju Hyun K; Korean J Gastrointest Endosc 2006;33(2):69-76. Published online August 30, 2006

Abstract PDF: Background
/Aims: This study compared the therapeutic efficacy of endoscopic band ligation (EBL) with that of electrocoagulation for treating non-variceal, non-ulcer (NVNU) upper gastrointestinal (UGI) bleeding. Methods: This study included 89 patients who underwent EBL and 56 patients in whom monopolar electrocoagulation was performed for NVNU UGI bleeding. The lesions treated were Mallory-Weiss tear in 91 patients, Dieulafoy's lesion in 42 patients and angiodysplasia in 12 patients. Results: The initial hemostatic rate was 97% in the EBL group and 91% in the electrocoagulation group, but this was not statistically different. Rebleeding occurred in 5 of 89 patients (5.6%) in the EBL group and in 8 of 56 patients (14.3%) in the electrocoagulation group (p=0.07). Thrombocytopenia or prothrombin time prolongation was confirmed to be a significant risk factor for rebleeding. The rebleeding rate in the high risk group was significantly lower than in the EBL group (9% vs. 30%, respectively, p=0.03). The median procedure time was significantly shorter in the EBL group compared with that in the electrocoagulation group (median 5.6 minutes vs. 8.3 minutes, respectively, p=0.04). Conclusions: EBL and electrocoagulation are both effective for treating NVNU UGI bleeding, and EBL is especially safe and effective for the cases with a high risk for rebleeding. (Korean J Gastrointest Endosc 2006;33:69⁣76)

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A Case of Rectal Dieulafoy's Lesion Treated by Endoscopic Band Ligation: Won Min Hwang, M.D., Hoon Seop Kuh, M.D., Tae Hee Lee, M.D., Ki Se Lee, M.D., Euyi Hyeog Im, M.D., Kyu Chan Huh, M.D., Young Woo Choi, M.D. and Young Woo Kang, M.D.; Korean J Gastrointest Endosc 2004;29(2):99-102. Published online August 30, 2004

Abstract PDF: Dieulafoy's lesion is a relatively uncommon disease which is minor cause of massive acute lower gastrointestinal bleeding. The lesion comprises mainly of an abnormally exposed submucosal artery associated with a minute mucosal defect on the top in the stomach, and it is a rare cause of profuse but intermittent gastrointestinal bleeding. Less commonly, similar lesions have also been identified in the duodenum, jejunum, colon, and in rare cases, the rectum. In this report, 70 year-old man is described, who has an massive hematochezia from a small rectal mucosal defect with an exposed vessel. Control of the bleeding was successfully achieved with endoscopic band ligation. The fact that rectal Dieulafoy's disease is rare but one of the causes of massive hematochezia should serve as a reminder in the future cases in the elderly. (Korean J Gastrointest Endosc 2004;29:99⁣102)

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A Case of Rectal Bleeding Treated by Endoscopic Band Ligation: Jeong Won Jang, M.D., Hiun Suk Chae, M.D., Je Hyun Shin, M.D., Kang Moon Lee, M.D.,Seong Soo Kim, M.D., Chun Sang Bang, M.D., Jin Il Kim, M.D., Suk Won Han, M.D.,Ki Bum Kim, M.D., Young Ok Kim, M.D., Seon Ahe Yun, M.D., Chang Don Lee, M.D.,Kyu Yong Choi,; Korean J Gastrointest Endosc 2001;22(4):229-232. Published online April 30, 2001

Abstract PDF: Endoscopic band ligation has been a standard therapy in esophageal varix bleeding since it was first introduced in 1980s. However, technical problems have interrupted as a therapeutic management of lower gastrointestinal bleeding. We report a case of successful management of rectal bleeding with endoscopic band ligation in patient with chronic renal failure, who had been managed by hemodialysis since eight months before. Successful control of rectal bleeding was achieved by endoscopic band ligation. Three days later, round and shallow ulcer developed at the ligated site, which was improved at follow-up sigmoidoscopy and bleeding was not observed any more. He was discharged without complications. Herein, we report the band ligation as a useful method in treatment of rectal bleeding. (Korean J Gastrointest Endosc 2001;22:229⁣232)

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내시경적 결찰요법으로 치료한 Rendu - Osler - Weber Disease 환자의 위장출혈 1 예 ( A Case of Endoscopic Band Ligation Therapy for Gastric Bleeding in Patient with Rendu - Osler - Weber Disease ): Korean J Gastrointest Endosc 2001;23(6):470-473. Published online November 30, 2000

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구연 / 포스터 : Rectal Dieulafoy`s Lesion: Korean J Gastrointest Endosc 2001;22(5):380-380. Published online November 30, 2000

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내시경 결찰술을 이용하여 치료한 위 동정맥 기형 1 예 ( A Case of Endoscopic Band Ligation Therapy in Gastric Arteriovenous Malformation ): Korean J Gastrointest Endosc 2000;21(3):741-745. Published online November 30, 1999

Abstract PDF: Although various endoscopic treatments, such as laser photocoagulation, electrocoagulation, heater probe, injection have been used for treatment of arteriovenous malformation (AVM), associated complications also have been reported. In order to avoid the complications, elastic band ligation has recently been used as an alternative method for endoscopic treatment of gastric AVM. A 58-year-old man was admitted due to hematemesis and melena. A gastroscopy revealed AVM with vessel exposure and active bleeding at the greater curvature of fundus, and we performed arteriography for emergency embolization, but, we do not find the bleeding vessel. Endoscopic band ligation therapy was performed as an alternative method for control of bleeding. 2 months later, follow-up endoscopy showed disappearance of AVM and no evidence of hemorrhage.

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Dieulafoy 병변 출혈에서의 내시경적 결찰술 ( Endoscopic Band Ligation in Bleeding Dieulafoy's Lesions ): Korean J Gastrointest Endosc 1999;19(4):537-544. Published online November 30, 1998

Abstract PDF: Background
/Aims: The Dieulafoy's lesion is an unusual cause of massive gastrointestinal bleeding resulting from the erosion of an abnormally large submucosal artery. Surgical intervention was believed to be the best treatment in the past, but recently improvement of endoscopic techniques has made effective hemostasis possible in most cases of Dieulafoy's lesions. Therapeutic endoscopic hemostasis includes sclerotherapy, electrocauterization, laser coagulotherapy, clipping band ligation. The effectiveness of the endoscopic band ligation was evaluated in bleeding Dieulafoy's lesions. Methods: Clinical characteristics, initial endoscopic findings, and effectiveness of band ligation in Dieulafoy's lesions were all analyzed. Results: 1) The patients were 8 males and 1 female, and the mean age was 56.2 years. 2) The chief complaints were melena and hematemesis, and 2 cases had histories of recurrent gastrointestinal bleeding. 3) The diagnosis of Dieulafoy's lesion was possible in 7 of 9 patients (78%) at the initial endoscopy. 4) The lesions were mostly located in the fundus and the body, characterized mainly by protruding vessels in shallow erosion areas. 5) The initial band ligation was possible with successful hemostasis, but additional sclerotherapy was necessary in two cases. There were no complications related to the procedure, except a case of early band detachment. Conclusions: The Dieulafoy's lesion requires careful endoscopic observation for diagnosis, and endoscopic band ligation was an effective therapeutic option for bleeding Dieulafoy's lesions. (Korean J Gastrointest Endosc 19: 537∼544, 1999)

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