From the Guidelines
Management of Watermelon Stomach (Gastric Antral Vascular Ectasia, GAVE) typically involves endoscopic treatments. The most effective approach is endoscopic band ligation (EBL) or endoscopic thermal methods such as argon plasma coagulation (APC) or radiofrequency ablation, which lead to decreased blood loss and reduced red blood cell transfusion requirements 1.
Key Considerations
- Endoscopic band ligation (EBL) is preferred due to its higher success rate, greater decrease in transfusion requirements, and more pronounced improvement in hemoglobin levels compared to endoscopic thermal methods 1.
- Iron repletion is essential for all patients with GAVE, which can be oral or intravenous depending on the severity of iron depletion and tolerance 1.
- Medical therapy with proton pump inhibitors (PPIs) and/or corticosteroids may be considered in some cases to reduce inflammation and promote healing, although its effectiveness is not well established for GAVE specifically.
Treatment Approach
- Patients with GAVE should undergo endoscopic evaluation to assess the extent of vascular ectasias and guide treatment.
- Endoscopic band ligation (EBL) or endoscopic thermal methods should be performed to control bleeding and reduce symptoms.
- Iron supplementation should be initiated to address iron deficiency anemia.
- Follow-up endoscopic evaluations should be scheduled to monitor the response to treatment and adjust the approach as needed.
From the Research
Management of Watermelon Stomach (Gastric Antral Vascular Ectasia, GAVE)
The management of watermelon stomach (Gastric Antral Vascular Ectasia, GAVE) involves a combination of general supportive care and endoscopic therapy. The goals of therapy are to eliminate or decrease the need for blood transfusions, hospitalization, office visits, and endoscopic therapy sessions aimed at cessation of GI blood loss and resolution of symptomatic anemia 2.
General Supportive Care
General supportive care includes:
- Transfusion of blood products as necessary to control symptomatic anemia and coagulopathy
- Iron replacement therapy by oral or parenteral routes
- Identification and treatment of iatrogenic (eg, warfarin) or hereditary (eg, von Willebrand's disease) coagulopathy
- Avoidance of substances that might cause gastric mucosal damage and/or bleeding (eg, aspirin, NSAIDs, alcohol) 2
Endoscopic Therapy
Endoscopic therapy options include:
- Multipolar electrocoagulation: a 10-Fr probe (3.2 mm in diameter) is used at a generator setting of 12 to 16 W 2
- Argon plasma coagulation (APC): a safe and effective treatment for GAVE, with a mean of 2.6 treatment sessions per patient required 3
- Band ligation: a safe and effective treatment for GAVE, with a mean number of treatments of 2.5 (1-5) 4
- Radiofrequency ablation: a novel technique that has been shown to be effective in treating GAVE 5
- Heater probe: an alternative treatment option for GAVE 2
Treatment Interval and Follow-up
The treatment interval can be gradually lengthened as the long-term goals of obliteration of angiomata and resolution of anemia are reached. Patients are routinely given standard doses of available proton-pump inhibitors (PPIs) to facilitate healing of iatrogenic ulcers and to prevent secondary bleeding 2.
Complications and Side Effects
Side effects may include iatrogenic ulceration at the site of treatment, bleeding, and transient abdominal pain. Antral scarring (after APC or Nd:YAG laser) and hyperplastic polyps have also been reported after endoscopic treatment of classic GAVE 2.
Surgical Intervention
Surgical antrectomy is very effective in the prevention of bleeding but has substantial (5% to 10%) mortality in older patients with comorbidity and is now reserved for endoscopic failures 2.