Recommended Citation
Stevenson JR, Ezeano C, Kashif M, Alsabbagh Alchirazi K, Kaura T, Mittal C, Kumar N, Kumar K. Beyond Argon Plasma Coagulation: Band-Based Therapy for Nodular Gastric Antral Vascular Ectasia — A Case Series. Poster presented at: American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting; October 11, 2026; Nashville, TN. Poster P1007.
Presentation Notes
Poster presented at: American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting; October 11, 2026; Nashville, TN. Poster P1007.
Abstract
Introduction: Argon plasma coagulation (APC) is traditional therapy for gastric antral vascular ectasia (GAVE), but nodular disease may not fully respond to superficial ablation. Endoscopic band ligation (EBL) may achieve durable eradication by capturing nodular mucosa. We describe five high-risk patients with nodular/friable GAVE managed with band-based therapy. Case Description/Methods: Five patients were identified via retrospective chart review (non-human-subjects determination). Four had cirrhosis with portal hypertensive gastropathy (PHG) and/or varices; one had advanced chronic kidney disease (CKD) with cardiovascular disease and anemia. Patient A, a woman in her 30s with decompensated cirrhosis (drug-induced vs metabolic alcoholassociated liver disease), presented with hemoglobin 3 g/dL requiring five transfusions; esophagogastroduodenoscopy (EGD) showed nodular hypertrophic GAVE with friability/excoriations treated with EBL ×5, then ×6. Patient B, a man in his 70s with CKD stage V, coronary/peripheral artery disease, ischemic cardiomyopathy, atrial fibrillation after left atrial appendage occlusion, and chronic anemia, had recurrent nodular/friable GAVE after repeated APC and underwent band mucosectomy ×6. Patient C, a woman in her 70s with steatohepatitis cirrhosis, end-stage renal disease on hemodialysis, and coronary disease on antiplatelet therapy, had APC-treated nodular GAVE; follow-up EGD showed oozing GAVE treated with EBL ×6 plus adjunct APC. Patient D, a man in his 50s with alcohol-related cirrhosis, varices, and prior spontaneous bacterial peritonitis, had ulcerated nodular GAVE with active oozing treated with serial EBL (×4). Patient E, a man in his 50s with alcohol-related cirrhosis, PHG, varices, ascites, and hepatic encephalopathy, had prominent friable nodular GAVE treated with EBL ×9; follow-up showed improvement and repeat EBL ×5. Discussion: Nodular GAVE was amenable to band-based therapy, including in cirrhotic and antithrombotic-burdened patients. All sessions were tolerated without procedural complications. Morphology may guide therapy: flat ectasia may remain suitable for APC, whereas nodular, bulky, friable, ulcerated, transfusion-sensitive, or recurrent lesions may respond better to band-based therapy. This supports earlier band-based therapy in selected GAVE phenotypes while distinguishing GAVE from PHG. AI use disclosure: Generative AI tools assisted with literature review and language editing; no patient-identifiable information was entered, and authors verified content. A B D D C E 123456789f12345678 Figure 1. Representative endoscopic findings in five patients with nodular, friable, or ulcerated gastric antral vascular ectasia (GAVE) managed with endoscopic band ligation or band mucosectomy. Panels (A–E) correspond to Patients A–E in the Case Description. (A) Nodular hypertrophic GAVE with friability and superficial excoriations. (B) Extensive nodular, friable, recurrent GAVE. (C) Oozing nodular GAVE. (D) Ulcerated nodular GAVE with active oozing. (E) Prominent friable nodular GAVE. These morphologies may favor band-based therapy over superficial thermal ablation in selected cases. Figure 2. Case-series summary of five high-risk patients with nodular, friable, ulcerated, recurrent, or previously argon plasma coagulation (APC)-treated gastric antral vascular ectasia (GAVE) managed with endoscopic band ligation or band mucosectomy. Shared features that may favor band-based therapy over superficial thermal ablation include bulky or nodular morphology, friability or oozing, recurrent disease after prior APC or cautery, and high bleeding or transfusion risk.
Type
Poster
Affiliations
Aurora Health Care, Aurora St. Luke's Medical Center