Role of endoscopy in the diagnosis and treatment of gastric mucosal lesions in liver cirrhosis patients

Table 1 Results of argon plasma coagulation for the treatment of gastric antral vascular ectasia

Ref.	Total number of patients /with LC	Other gastric mucosa lesions	Number of APC sessions	Follow-up (month)	Efficacy	Recurrence, treatment failure, post-treatment blood transfusions, adverse events, complications
Probst et al[44]	17/6	N/A	2.2 (range 1-4)	30.4 (range 1-65)	Endoscopic success was 100%	Recurrence was 29.4%; one patient (5.9%) needed post-treatment blood transfusions; one patient (5.9%) developed antrum stenosis
Yusoff et al[45]	5/3	N/A	2.6 (range 1-4)	20 (range 14-27)	Endoscopic success was 100%	Recurrence was 40%; two patients (40%) needed post-treatment blood transfusions
Sebastian et al[46]	12/2	N/A	Median 2 (range 1-5)	Median 3 (range 1-4)	Endoscopic success was 100%	Two patients (16.7%) needed post-treatment blood transfusions; one of them had ulcer bleeding, second patient had no cause for blood loss identified at repeat endoscopies
Sato et al[47]	8/8	One patient (12.5%) had EV, one patient (12.5%) had PHG	1.8 (range 1-3)	28 (range 12-47)	Endoscopic success was 100%	Recurrence was 25%
Lecleire et al[48]	30/17	Eleven LC patients (64.7%) had EV, four LC patients (23.5%) had PHG	2.18 ± 1.74 in LC patients	Median 20 in LC patients	Endoscopic success in LC patients was 88.2%	Nine LC patients (53%) died during the follow-up; two LC patients (11.8%) who were not successfully treated died from intractable overt bleeding
Herrera et al[49]	8/ N/A	N/A	Median 3 (range 1-10)	28	Endoscopic success was 87.5%	One patient had a recurrence acute upper gastrointestinal bleeding 15 months after treatment completion
Fuccio et al[50]	20/20	All patients had EV, thirteen of them (65%) underwent EBL	Median 4.6 ± 4.6	N/A	Endoscopic success was 100%	Recurrence was 30%; two patients (10%) needed post-treatment blood transfusions; gastric hyperplastic polyps developed in 3 patients (15%) causing active bleeding in 2 cases
Naga et al[51]	29/22	Thirteen patients (44.8%) had PHG	Median 4.6 ± 4.6 (range 1-17)	N/A	N/A	Three patients (10.4%) required post-treatment blood transfusions
Sato et al[52]	22/20	Twelve LC patients (60%) had EV	2.3 (range 1-3)	16.6	There was no need for blood transfusion in most cases	Recurrence was 68.2%; seven patients (31.8%) died during follow-up period, including two cases with bleeding-related deaths
Chiu et al[53]	19/12	Five patients (26.3%) had PHG	2.4 ± 1.4	N/A	Endoscopic success was about 80%	Rebleeding occurred in 15 patients (78.9%); the median duration of rebleeding after treatment was 23 days; three LC patients (25%) died of rebleeding
Keohane et al[54]	15/N/A	Three patients (20%) had PHG	4.1 (range 1-11)	26 (range 1-60)	Endoscopic success was 46.7%	There was a non-significant increase from 7.7 to 9.3 post-treatment blood transfusions
Elhendawy et al[55]	44/44	N/A	3.48 ± 0.902	6	N/A	Nine patients (20.5%) had adverse events, in the form of fever in two patients, abdominal distension in four patients and epigastric pain in three patients
Garg et al[56]	20/16	Four LC patients (25%) had EV	Median 2 (range 1-7) in LC patients	Median 20 (range 2-65)	Endoscopic success was 40%	Recurrence was 25%
Fábián et al[57]	45/17	N/A	4.43 ± 0.76 (for endoscopic remission)	13.49 ± 2.46	There was a significant increase in hemoglobin levels and a decrease in the need for blood transfusion	Complications occurred in four patients (8.8%): Two patients (4.4%) had Mallory-Weiss syndrome and two patients (4.4%) had gastric ulceration without active bleeding resulting in scarring

LC: Liver cirrhosis; GAVE: Gastric antral vascular ectasia; APC: Argon plasma coagulation; EV: Esophageal varices; PHG: Portal hypertensive gastropathy; EBL: Endoscopic band ligation; N/A: Not available.

Table 2 Results of radiofrequency ablation for the treatment of gastric antral vascular ectasia

Ref.	Total number of patients /with LC	Other gastric mucosa lesions	Number of RFA sessions	Follow-up (month)	Efficacy	Recurrence, treatment failure, post-treatment blood transfusions, adverse events, complications
Gross et al[60]	6/N/A	One patient (16.7%) had superficial gastric ulcer	1.7 (range 1-3)	N/A	There was a significant increase in hemoglobin levels	One patient (16.7%) remained dependent on blood transfusions, but the overall need for blood transfusion decreased
McGorisk et al[61]	21/18	Two patients (9.5%) had EV, five patients (23.8%) had PHG	1.9 ± 0.6 (range 1-3)	6	Technical and clinical successes were 90% and 86%, respectively	Three patients (14.3%) required post-treatment blood transfusions; one patient (4.8%) had superficial gastric ulceration, one patient (4.8%) had ulcer bleeding and one patient (4.8%) continued to have GAVE associated bleeding
Dray et al[62]	24/11	N/A	1.8 ± 0.8 (range 1-3)	6	There was a significant increase in hemoglobin levels and a decrease in the need for blood transfusion	There were no reports of any perioperative or inpatient postoperative complications
Jana et al[63]	7/2	N/A	Median 2 (range 1-3)	Median 6 (range 8-15)	Technical and clinical successes were 100% and 71%, respectively	Two patients (29%) required post-treatment blood transfusions; there were no reports of any perioperative or inpatient postoperative complications
Raza et al[64]	9/4	One LC patient (25%) had PHG	Median 3 (range 2-6)	Median 11 (range 6-21)	Technical success was 100%	Three patients (33.3%) had a recurrence of GAVE, and required blood transfusions and retreatment
Dunn et al[65]	15/3	N/A	Median 2	Median 2 (range 1-6)	Clinical and endoscopic responses were 87% and 20%, respectively. There was a significant increase in hemoglobin levels and a decrease in the need for blood transfusion	Four patients (26.7%) required post-treatment blood transfusions
Markos et al[66]	15/0	N/A	Median 2 (range 1-3)	Median 11 (range 5-18)	Technical and clinical successes were 100% and 80%, respectively. There was a significant increase in hemoglobin levels	Five patients (33.3%) required post-treatment blood transfusions
Senzolo et al[67]	40/40	N/A	N/A	6	There was a significant increase in hemoglobin levels and a decrease in the need for blood transfusion	No major complication occurred and liver function remained stable in all patients
Magee et al[68]	20/4	N/A	Median 2 (range 1-2)	6	There was a significant increase in hemoglobin levels	Three patients (15%) required post-treatment blood transfusions; three patients (15%) experienced epigastric pain which was managed with oral pain medications

LC: Liver cirrhosis; GAVE: Gastric antral vascular ectasia; RFA: Radiofrequency ablation; EV: Esophageal varices; PHG: Portal hypertensive gastropathy; N/A: Not available.