Watermelon stomach: endoscopic management

Aims: A review of all cases of Gastric Antral Vascular Ectasia (GAVE), also known as Watermelon stomach presenting to a University teaching hospital.

Methods: A review of all the endoscopy and clinical records of patients presenting to our service between 2003–05. We reviewed the presenting symptoms, laboratory findings and treatment regimens of patients attending the gastroenterology unit. A review of the literature was also undertaken.

Results: 7 patients presented to the gastroenterology unit. The majority were tertiary referrals. The main reason for referral was iron deficiency anaemia. The mean haemoglobin on referral was 7.8g/l. The majority were managed with endoscopic argon plasma coagulation (APC). 2 patients are still undergoing endoscopic treatment. 2 patients completed treatment, requiring at least 5 sessions of APC, and are now transfusion independent. 2 patients died from unrelated complications prior to completing treatment. One patient required surgical antrectomy due to overt GI haemorrhage not amenable to endoscopic therapy.

Conclusions: Watermelon stomach is an increasingly recognised cause of iron deficiency anaemia/occult GI haemorrhage, often confused as gastritis. Whilst treatment options are varied endoscopic photocoagulation offers a safe effective modality, and reduces transfusion requirements.