Cooper JA, Statham E, Holyfield A, Shoreibah MG, Peter S. Initial treatment approaches for nodular gastric antral vascular ectasia: A comparison of endoscopic band ligation and thermal therapies. World J Gastrointest Endosc 2025; 17(12): 111872 [DOI: 10.4253/wjge.v17.i12.111872]
Corresponding Author of This Article
John Andrew Cooper, MD, Tinsley Harrison Internal Medicine Residency Program, The University of Alabama at Birmingham, 1808 7th Avenue South, Birmingham, AL 35294, United States. jacooper4196@gmail.com
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Gastroenterology & Hepatology
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 16, 2025 (publication date) through Dec 19, 2025
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World Journal of Gastrointestinal Endoscopy
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1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Cooper JA, Statham E, Holyfield A, Shoreibah MG, Peter S. Initial treatment approaches for nodular gastric antral vascular ectasia: A comparison of endoscopic band ligation and thermal therapies. World J Gastrointest Endosc 2025; 17(12): 111872 [DOI: 10.4253/wjge.v17.i12.111872]
World J Gastrointest Endosc. Dec 16, 2025; 17(12): 111872 Published online Dec 16, 2025. doi: 10.4253/wjge.v17.i12.111872
Initial treatment approaches for nodular gastric antral vascular ectasia: A comparison of endoscopic band ligation and thermal therapies
John Andrew Cooper, Elizabeth Statham, Ada Holyfield, Mohamed G Shoreibah, Shajan Peter
John Andrew Cooper, Elizabeth Statham, Tinsley Harrison Internal Medicine Residency Program, The University of Alabama at Birmingham, Birmingham, AL 35294, United States
Ada Holyfield, Department of Gastroenterology, The University of Alabama at Birmingham, Birmingham, AL 35294, United States
Mohamed G Shoreibah, Shajan Peter, Department of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, AL 35294, United States
Author contributions: Cooper JA, Statham EG, Holyfield A, Shoreibah MG, and Peter S participated in the conception and design of the study and were involved in the acquisition, or interpretation of data; John C wrote the manuscript; Cooper JA, Statham EG, Holyfield A, Shoreibah MG, and Peter S critically reviewed and provided final approval of the manuscript and were responsible for the decision to submit the manuscript for publication.
Institutional review board statement: This investigation was approved by the Institutional Ethics Committee of The University of Alabama at Birmingham.
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data supporting the findings of this retrospective study are derived from medical records and are not publicly available due to privacy concerns. However, de-identified data may be made available upon reasonable request to the corresponding author, subject to approval by the University of Alabama at Birmingham, IRB. Access will be granted in compliance with applicable data protection regulations and institutional guidelines.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: John Andrew Cooper, MD, Tinsley Harrison Internal Medicine Residency Program, The University of Alabama at Birmingham, 1808 7th Avenue South, Birmingham, AL 35294, United States. jacooper4196@gmail.com
Received: July 11, 2025 Revised: August 18, 2025 Accepted: November 7, 2025 Published online: December 16, 2025 Processing time: 158 Days and 9.4 Hours
Abstract
BACKGROUND
Gastric antral vascular ectasia (GAVE) accounts for up to 4% of nonvariceal upper gastrointestinal bleeding. Argon plasma coagulation and radiofrequency ablation have been primary treatment modalities for patients with linear and punctate subtypes, with a newer trend of utilization of endoscopic band ligation (EBL). This study evaluates the outcomes of patients undergoing treatment for nodular GAVE. We hypothesize that patients treated initially with EBL will achieve higher rates of clinical remission with fewer endoscopic treatments and a shorter treatment interval.
AIM
To investigate the effects of EBL as an initial treatment therapy on outcomes associated with nodular GAVE.
METHODS
A total of 37 patients at a tertiary medical center with nodular GAVE were included in this retrospective study. The study population was divided between those treated initially with EBL (initial EBL) and initial endoscopic thermal therapy. Pre-treatment and post-treatment hemoglobin values, the model for end-stage liver disease scores, hospitalization rates, and other outcomes. Additionally, endoscopic treatment modality type and frequency were recorded, including radiofrequency ablation, argon plasma coagulation, and EBL. Continuous variables were compared using a t-test, while categorical variables were compared using Fisher’s exact.
RESULTS
Linear regression analysis displayed a positive relationship between the time interval from initial therapeutic esophagogastroduodenoscopy to first EBL treatment and overall treatment interval (t = 7.39, P < 0.001), as well as between the number of endoscopic treatments (t = 8.09, P < 0.001). Hemoglobin levels increased in both the initial EBL group (8.7 vs 11.4, P < 0.001) and the initial endoscopic thermal therapy group (8.6 vs 10.4, P = 0.042). Clinical remission rates were higher in the initial EBL group (90% vs 69% P = 0.041), with a non-significant trend of higher endoscopic remission rates (57.1% vs 37.5%, P = 0.270).
CONCLUSION
The observed trend favoring EBL, combined with its association with improved clinical remission and reduced treatment burden, supports its consideration as a preferred initial treatment approach.
Core Tip: Nodular gastric antral vascular ectasia (GAVE) is a rare and treatment-resistant subtype of GAVE with limited data guiding optimal therapy. This retrospective study compares endoscopic band ligation (EBL) and endoscopic thermal therapy, including argon plasma coagulation and radiofrequency ablation, as initial treatments for nodular GAVE. Patients initially treated with EBL achieved significantly higher clinical remission rates, required fewer procedures, and had shorter treatment intervals. These findings suggest that EBL may be a more effective first-line treatment for nodular GAVE, offering improved outcomes and reduced treatment burden compared to traditional thermal modalities.
