Gastric antral vascular ectasia (GAVE) is an uncommon but clinically significant cause of chronic gastrointestinal bleeding and iron-deficiency anemia. Endoscopic therapy is the mainstay of treatment, particularly when medical management is insufficient. Multiple modalities have been evaluated, with differences in depth of injury, technical complexity, durability, and recurrence rates. Missing data on therapy related to morphology of GAVE are still awaiting.

The aim of the present study was to start to fill the literature gap to define an endoscopic rationale for treatment of GAVE

A retrospective analysis on endoscopic treatment of GAVE was conducted in our tertiary referral center. The patients were divided in two groups depending on the morphology of GAVE: diffuse or nodular type. Primary endpoint was clinical success based on absence of Hb decrease and no need for blood transfusion at 6 months. Statistical analysis was accordingly performed.

277 patients were included in the present study, 195 affected by diffuse type and 82 by nodular type. All patients with diffuse type were treated by thermal ablation (APC or dual emission laser ablation) showing 80% of clinical success as defined in Methods. No patients with clinical insuccess were treated by EBL in this group.

Patients with nodular type were generally treated by APC as first line treatment (80 patients) and in two cases directly by EBL. APC treatment showed in this setting 60% of clinical success (significantly lower than in the diffuse type). Furthermore, only 20 patients out of 80 were treated by EBL as secondary approach. These patients showed a cumulative clinical success of 87,5%.

Statistical analysis confirmed a significant difference of clinical success in nodular type group between APC treatment and EBL (p=0,01).

Our study preliminarly demonstrate that thermal ablation is effective in diffuse type of GAVE while nodular type is better treated by EBL.