الفهرس 
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Abstract
Gastric antral vascular ectasia (GAVE) is an uncommon but significant cause of upper gastrointestinal bleeding that is responsible for about 4% of non‐variceal upper gastrointestinal (GI) bleeding. Patients with GAVE can present with overt GI bleeding in the form of intermittent melena and occasionally, hematemesis. The diagnosis of GAVE is achieved on the basis of endoscopic and histological appearance. Endoscopically there are two types of GAVE, Watermelon or stripped type and diffuse type.
Approximately 30 % of patients with GAVE have cirrhosis, while approximately 2 – 12 % of cirrhotic develop GAVE. It has been reported in other medical conditions including bone marrow transplantation, chronic renal failure, ischemic heart disease, hypertension, valvular heart disease, familial Mediterranean fever and acute myeloid leukemia.
The optimal treatment for GAVE is unknown. Before 1990, surgical antrectomy was the treatment of choice. However, surgery carries a significant risk of mortality and morbidity in cirrhotic patients. Recently, endoscopic techniques have become the treatment of choice for GAVE and several endoscopic treatments have been used successfully, including cryotherapy, electrocoagulation, heat probe, argon plasma coagulation (APC) and endoscopic band ligation (EBL).
The aim of this work is to compare between argon plasma coagulation (APC) and endoscopic band ligation (BL) of gastric mucosa in patients with chronic HCV- related liver cirrhosis with GAVE induced upper GIT bleeding.
Patients were divided into two groups
1- group 1: fifteen patients had undergone APC.
2- group 2: fifteen patients had undergone EBL.
Patients with Upper GIT bleeding caused by causes other than GAVE (for example, esophago-gastric varices, peptic ulcer, gastroduodenitis, severe portal hypertensive gastropathy) and patients with other causes of GAVE(for example, chronic renal failure, bone marrow transplantation, cardiac diseases, autoimmune diseases) were excluded from the study.
After giving their written consent all the patients were subjected to:
A- Detailed history taking with stress on history of upper GIT bleeding (hematemesis and or melena).
B- Thorough clinical examination with stress on general signs of anemia (pallor and tachycardia), abdominal examination (hepatomegaly, splenomegaly and ascites) and signs of liver disease.
C- Laboratory investigations: complete blood picture, hemoglobin monthly for three months, blood urea, serum creatinine, liver profile (serum albumin, serum bilirubin, serum transaminases and prothrombin time and activity), serum HBs Ag and HCV Ab(3rd generation ELISA) and PCR HCV RNA.
All the patients were classified according to the Child-Pugh score.
D- Specific investigations:
1- Abdominal ultrasonography
To assess the presence of liver cirrhosis, portal hypertension and splenomegaly.
2- Upper GIT endoscope.
- Diagnostic Upper GI endoscopy for all patients with identifying the type of GAVE either diffuse or stripped (water-melon) type.
Therapeutic Upper GIT endoscopy
A- group I had undergone APC (argon plasma coagulation).
B- group II had undergone EBL (endoscopic band ligation).
- After both procedures, patients were treated with omeprazole (20mg per day) to promote healing of the coagulated tissues / sites of band ligation.
- Patients of both groups were followed monthly for 3 months by upper GI endoscopy, history of bleeding recurrence (hematemesis or melena), hemoglobin level and need for hospitalization and blood transfusion.
The results of the present study showed the following:
1- Age of the patients in group I (APC group) ranged between 45 and 65 years with a mean of 54.6 ± 6.08 years and in group II (BL group),ranged between 47 and 70 years with a mean of 58.07 ± 6.9 years.The male gender was predominant in both groups representing 60%, 66.7% respectively.
2- 13 patients in group I (86.7%) and 15 patients in group II (100%) presented with melena and only 2 patients in group I (13.3%) presented with hematemesis.
3- In APC group (group I) (26.7% child A,73.3% child B) while in EBL group (group II) (20% child A,73.3% child B,6.7% child C).
4- In initial endoscopy, group I (7 patients (46.7%) had diffuse type GAVE,8 patients (53.3%) had stripped type,5 patients (33.3%) had F 1 esophageal varices,7 patients (46.7%) had mild portal hypertensive gastropathy) while in group II (7 patients (46.7 %) had diffuse type GAVE,8 patients (53.3%) had stripped type,7 patients (46.7%) had F 1 esophageal varices,9 patients (60%) had mild portal hypertensive gastropathy).
5- In group I ( the mean value of hemoglobin level was 10.10 ± 0.83 g/dl at the first month of the study before starting APC sessions, 9.11± 1.28 g/dl at the second month and 9.27±1.18 at the third month),while in group II (the mean value of hemoglobin level was 10.67± 0.88 g/dl at the first month of the study before starting EBL sessions, 11.03± 0.99 g/dl at the second month and 11.03±0.67 at the third month) group II (BL group) had significantly higher Hb level than group I (APC group) during the second and the third month of the study.