Combination sclerotherapy and band ligation for refractory transfusion-dependent nodular gastric antral vascular ectasia (GAVE): inducing submucosal scarring

Nodular GAVE is a rare variant more common in cirrhosis that often does not respond to conventional endoscopic therapies. We present a case series of patients with cirrhosis and transfusion-dependent refractory nodular GAVE managed with serial combination sclerotherapy with sodium tetradecyl sulfate (STS) and band ligation.

We report baseline characteristics and transfusion-related outcomes for 4 consecutive patients who underwent combination therapy.

STS was administered every 1 to 2 months, with the total number of sessions ranging from 5 to 8 over a median 12.3 months. One moderate adverse event, a large gastric ulcer that ultimately fully healed, occurred. At a median follow-up of 40.4 months, the frequency of transfusions had declined from 1.0 to 2.5 per month to 0 to 0.2 per month. The mean hemoglobin levels increased from 7.7 to 10.9 g/dL.

Combination sclerotherapy and band ligation resulted in a durable reduction in transfusion requirements and substantially increased hemoglobin for patients with cirrhosis and refractory nodular GAVE. It is postulated that STS injection may limit neovascularization driving nodular GAVE recurrence.