Background <p>Endoscopic management of gastric antral vascular ectasia (GAVE) is challenging. Most of the published studies investigated the role of argon plasma coagulation (APC). However, comparing APC versus endoscopic band ligation (EBL) is still underestimated. Therefore, this study aimed to evaluate and compare efficacy and safety of EBL and APC in management of GAVE.</p> Methods <p>Between April 2022 and April 2024, a randomized, controlled study was conducted in EL-Rajhi&#xa0;endoscopy unit at Assuit&#xa0;university hospital to enroll all patients endoscopically diagnosed with GAVE. Each patient was randomly assigned to his group using quick Calcs method for randomization. Post-procedure follow-up after 3 months and 6 months to evaluate potential complications.</p> Results <p>A total of 30 patients diagnosed endoscopically with gastric GAVE were randomly divided into two groups: APC group including 16 patients (62.5% males and 37.5% females), their median age was 64.00, and EBL group including 14 patients (71.4% males and 28.6% females), their median age was 65.00. We found that both EBL and APC were effective in successful management of GAVE and improving hemoglobin level (<i>p</i> &lt; 0.001) and decreased the need for blood transfusion with no statistically significant difference between the two groups (<i>p</i> 0.732). However, EBL was superior to APC in fewer number of endoscopic sessions needed for endoscopic remission of GAVE (<i>p</i> &lt; 0.001). There were no significant differences in complications between the two groups (<i>p</i> &gt; 0.056).</p> Conclusion <p>APC and EBL are effective in the management of GAVE. However, EBL is potentially superior in fewer number of treatment sessions, but not in the extent to which the two methods improved hemoglobin level and blood transfusion needed. Further studies with large numbers, different inclusions are needed.</p>