What is your endoscopic approach to the management of refractory GAVE in persistently anemic patients?

Approaches that I use:

• Reduce PPI use if able. There is some data that PPIs may make GAVE/DAVE and PHG worse and on occasion, stopping PPI has improved the overall appearance.
• Some positive data regarding the use of beta blockers for GAVE, although not that great.
• Depending on the definition of refractory, in this case, APC or even banding if there is a nodular component to it. Even without a nodular component, if there are areas of more severity, then banding can be effective.