In this case, a decision was made to change from APC to Banding for the following reasons: although one could treat nodular GAVE with APC, after initial therapy, I realized that there may be underlying veins or varices (although no esophageal or gastric varices and no chronic liver disease) and palpated the nodular swellings with APC probe. The nodules felt soft and fluctuant, indicative of cystic structures. Therefore decided to change therapy to band ligation based on a recent study showing that ligation therapy is helpful in patients who are refractory to repeated therapy with argon plasma coagulation.
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