Endoscopic management of bleeding portal hypertensive congestive Gastroathy. A prospective controlled randomized trial

Back ground: Argon Plasma Coagulation (APC) is the standard treatment of Portal Hypertensive Gastropathy (PHG). Endoscopic Band Ligation (EBL) is emerging as a new modality for treatment of PHG. Objective: Compare the effect of APC to EBL for the treatment of bleeding PHG in cirrhotic patients. Patients and methods: The study was conducted on 236 patients over a period of 30 months. The patients were divided into two groups as follows: • Group A (control group):124 patients who underwent primarily APC irrespective of the severity of PHG and • Group B (study group) :112 patients were managed by EBL of the gastric mucosal lesions also irrespective of their severity. Sessions were applied every 3 weeks till adequate endoscopic ablation was achieved. Regular follow-up and endoscopic assessment within 6 months Results: The efficacy to eradicate PHG (response to treatment) was 95.1% in APC group and 98.2% in EBL group. The number of endoscopic sessions needed to eradicate PHG was significantly less in EBL group (2.02 ±0.75) than in APC group (4.01±0.34).During the follow-up period, patients in APC group had significantly high rate of re-bleeding from recurrent PHG compared to EBL group mainly in patients with initially severe PHG Conclusion: Both treatment by APC and EBL are effective methods in treatment of bleeding from PHG ,however, EBL seems to be a significantly more effective modality on the long term follow up and prevention of recurrence.