Endoscopic Management of Gastric Antral Vascular Ectasia
Summary
Gastric antral vascular ectasia (GAVE) is a distinctive vascular lesion of the gastric antrum characterised by dilated mucosal capillaries and venules that present endoscopically as red stripes or spots radiating from the pylorus. Often associated with cirrhosis, systemic sclerosis and other chronic conditions, GAVE is a recognised cause of chronic blood loss leading to iron-deficiency anaemia and, less commonly, acute gastrointestinal haemorrhage. Endoscopic therapy has become the cornerstone of management, with thermoablative techniques such as argon plasma coagulation (APC) dominating first-line treatment due to their safety profile and ease of use. Mechanical approaches, notably endoscopic band ligation (EBL), have emerged as effective alternatives or adjuncts, particularly in patients refractory to APC or at risk of mucosal injury. More recent innovation includes radiofrequency ablation (RFA) and cryotherapy, which offer targeted mucosal destruction with limited surrounding tissue damage. Despite advances, most endoscopic modalities require repeat interventions to maintain durable haemostasis, and the choice of technique often reflects local expertise, lesion morphology and patient comorbidity. Surgical antrectomy remains a salvage option in transfusion-dependent or refractory cases. Optimising the sequence, combination and timing of endoscopic treatments is key to reducing relapse, minimising transfusion requirements and improving quality of life.
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Endoscopic Management of Gastric Antral Vascular Ectasia publication trend
The graph below shows the total number of articles in endoscopic management of gastric antral vascular ectasia across all publications each year (not limited to Nature Index journals).
Technical terms
Gastric antral vascular ectasia (GAVE): A condition characterised by ectatic blood vessels in the gastric antrum causing chronic or acute bleeding.
Argon plasma coagulation (APC): A non-contact thermal ablation technique that uses ionised argon gas to coagulate superficial mucosal vessels.
Endoscopic band ligation (EBL): A mechanical method in which rubber bands are applied to vascular lesions to induce ischaemic necrosis.
Radiofrequency ablation (RFA): An energy-based technique employing controlled radiofrequency current to ablate targeted tissue with minimal penetration depth.
References
- Gastric antral vascular ectasia: the evolution of therapeutic modalities. Endoscopy International Open (2014).
- Radiofrequency Ablation for Treatment of Refractory Gastric Antral Vascular Ectasia: A Systematic Review of the Literature. Gastroenterology Research and Practice (2017).
- To coagulate, ligate, or both: a randomized study comparing the safety and efficacy of two endoscopic approaches for managing gastric antral vascular ectasia in cirrhotic patients. Egyptian Liver Journal (2022).
- Endoscopic eradication of nodular gastric vascular antral ectasia by using band ligation after argon plasma coagulation. Revista de Medicină Militară (2019).
- A Case of Refractory Gastric Antral Vascular Ectasia Treated Successfully With Distal Gastrectomy and Billroth II Reconstruction. Cureus (2023).
About these summaries
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