From the Guidelines
Management of watermelon stomach (Gastric Antral Vascular Ectasia, GAVE) typically involves endoscopic treatments, such as endoscopic band ligation (EBL) or thermal methods like argon plasma coagulation, to control bleeding and reduce symptoms.
Key Treatment Options
- Endoscopic band ligation (EBL) is a preferred treatment option, as it has been shown to lead to decreased blood loss and reduced red blood cell transfusion requirements, with a greater decrease in transfusion requirements compared to thermal methods 1.
- Thermal methods, such as argon plasma coagulation, can also be effective in managing GAVE, although EBL may be more effective in reducing transfusion requirements and improving hemoglobin levels 1.
- Iron repletion, either oral or intravenous, is also essential for patients with GAVE, especially those with iron-deficiency anemia, to replenish iron stores and promote healing 1.
Treatment Approach
In individuals with iron-deficiency anemia secondary to GAVE who have an inadequate response to iron replacement, consider endoscopic therapy with EBL or thermal methods such as argon plasma coagulation 1. It is worth noting that while medical therapy with proton pump inhibitors (PPIs) and/or corticosteroids may be considered in some cases, there are no proven pharmacologic therapies for GAVE, and endoscopic treatments remain the primary approach to managing this condition 1.
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.