Insights into the management of gastric antral vascular ectasia (watermelon stomach)

Abstract

Gastric antral vascular ectasia (GAVE) is an uncommon but important cause of chronic gastrointestinal bleeding. It is often associated with systemic diseases such as autoimmune diseases, liver cirrhosis, chronic renal insufficiency and cardiovascular disease. The etiology of GAVE has not been fully explored and remains controversial. Diagnosis is mainly based on endoscopic presentation with flat or raised erythematous stripes radiating from the pylorus to the antrum and resembles a watermelon. Clinical presentation may range from iron-deficiency anemia secondary to occult blood loss, melena to hematemesis. In past decades, many therapeutic modalities including medical, endoscopic and surgical intervention have been introduced for GAVE treatment with variable efficacy. Herein, we review the efficacy and safety of these treatment options for GAVE.

Intra-Arterial Embolization as a Treatment Option in a Case of GAVE Syndrome

“…1,10 The effectiveness of medical management has only been reported in case reports/case series and need randomized control trials to find efficacy and drug safety. 18 Endoscopic treatment is a preferred treatment option and includes band ligation, cryotherapy, argon plasma coagulation, neodymium-yttrium-aluminum-garnet laser coagulation, radiofrequency ablation, and sclerotherapy. 11,18 APC is the treatment of choice in patients with GAVE and has shown effective results in both bleeding and rebleeding.…”

“…18 Endoscopic treatment is a preferred treatment option and includes band ligation, cryotherapy, argon plasma coagulation, neodymium-yttrium-aluminum-garnet laser coagulation, radiofrequency ablation, and sclerotherapy. 11,18 APC is the treatment of choice in patients with GAVE and has shown effective results in both bleeding and rebleeding. 18 Surgical treatment is reserved as a last resort in these cases; however, it comes at the cost of significant morbidity and mortality rates.…”

“…11,18 APC is the treatment of choice in patients with GAVE and has shown effective results in both bleeding and rebleeding. 18 Surgical treatment is reserved as a last resort in these cases; however, it comes at the cost of significant morbidity and mortality rates. 4 No controlled studies have been performed to suggest if medical-surgical treatment options are superior.…”

Laparoscopic subtotal gastrectomy with Roux-en-Y reconstruction for long-term anticoagulation in gastric antral vascular ectasia syndrome

“…Surgical treatment is typically reserved for extenuating circumstances and includes gastric antrectomy followed by a Billroth II or Roux-en-Y reconstruction. This has been associated with high success rates with long-term haemostasis and no transfusion requirements in a study with 2-year follow-up 3…”

“…As a result, approximately 62% of these patients become transfusion dependent 2. GAVE syndrome is commonly mistaken for gastritis but can be histologically characterised by vascular ectasia of the mucosal capillaries, focal thrombosis and spindle cell proliferation within the lamina propria 2 3…”