• CKD
• Case report
• Gave
• Hemodialysis

• Humans
• Male
• Gastric Antral Vascular Ectasia/diagnosis
• Gastric Antral Vascular Ectasia/complications
• Gastric Antral Vascular Ectasia/therapy
• Aged
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/therapy
• Renal Insufficiency, Chronic/diagnosis
• Incidental Findings
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Nepal
• Renal Dialysis
• Gastritis/diagnosis
• Gastritis/complications
• Gastritis/therapy
• Argon Plasma Coagulation
• Melena/etiology

• antrectomy
• argon plasma coagulation
• endoscopic band ligation
• endoscopy
• gastrectomy
• gastric antral vascular ectasia
• gastrointestinal bleeding
• surgery
• watermelon stomach

• Humans
• Gastric Antral Vascular Ectasia/diagnosis
• Gastric Antral Vascular Ectasia/complications
• Gastric Antral Vascular Ectasia/pathology
• Dilatation, Pathologic/complications
• Stomach Neoplasms/pathology
• Polyps/diagnosis
• Polyps/pathology
• Fibrin

• Humans
• Gastric Antral Vascular Ectasia/diagnosis
• Gastric Antral Vascular Ectasia/therapy
• Electrocoagulation
• Liver Cirrhosis
• Gastrointestinal Hemorrhage

Gastric Antral Vascular Ectasia is a rare disorder that causes up to 4 % of severe acute gastrointestinal bleeding. It affects elderly females with iron deficiency anemia due to chronic blood loss as a common presenting sign.

We report the case of a 70-year-old man admitted to the Urgency Department for severe asthenia associated with abdominal pain and severe anemia. An urgent upper endoscopic examination showed antral hyperemic streaks and vascular ectasias extending from the pyloric ring to the gastric body as well as signs of recent bleeding. Histological results demonstrated the pathognomonic features of GAVE.

The first line treatment is considered argon plasma coagulation (APC), given its wider availability, safety, efficacy and cost-effectiveness. In current literature, other therapies and different types of endoscopic treatments have been proposed, such as EBL, RFA and Yag: laser. To date, there is no specific recommendation that privileges one method over another in the treatment of GAVE, although APC has proven effective and even better in terms of complications and costs than the other techniques.

In our experience, endoscopic coagulation with APC probes is a relatively easy-to-use technique with low cost, minimal invasiveness and provides immediate results.

On the other hand, a standardized algorithm is also required concerning to the different subtypes to give the best treatment in every case.

Gastric antral vascular ectasia (GAVE) is an unusual cause of upper gastrointestinal (GI) bleeding in an elderly patient.

A 73-year-old female with erosive gastritis, hypertension, and unstable angina arrived at the emergency department with shortness of breath, easy fatigability, and melaena. Physical examination indicated pallor but no signs of distress, with an unremarkable systemic examination. Routine blood testing indicated anemia. The patient underwent upper gastrointestinal endoscopy, which revealed linear red ectatic vessels radiating from the antrum towards the body. A diagnosis of GAVE was made. Blood transfusions and argon plasma coagulation were undertaken.

This condition is an uncommon cause of upper GI bleeding with the antrum being the most prevalent site. The pathophysiology of GAVE is yet unknown, however, many hypotheses have been postulated. GAVE is frequently misdiagnosed as gastritis. GAVE treatment comprises initial resuscitation and symptomatic treatment with intravenous fluids and blood products. Endoscopy has increasingly been the first-line therapeutic option for GAVE in recent years, including argon plasma coagulation.

The diagnosis of gastric antral vascular ectasia is frequently overlooked during upper GI endoscopy, despite the fact that it should always be explored, especially in cases of unexplained GI bleeding in the elderly.

•

An unusual cause of upper gastrointestinal bleeding in an elderly patient.

Gastric antral vascular ectasia (GAVE) has diverse associations and presumed causes, which include liver cirrhosis, chronic kidney disease, and autoimmune disease. This heterogeneity of underlying disorders suggests that the pathogenesis of GAVE may be variable.

To compare the clinical features and long-term outcomes of GAVE according to endoscopic patterns and etiologies.

The medical records and endoscopic images of 23 consecutive patients diagnosed with GAVE by endoscopy at Yeungnam University Hospital from January 2006 to December 2020 were retrospectively reviewed. Patients were allocated to cirrhosis (16 patients) and non-cirrhosis groups (7 patients). GAVE subtypes, as determined by endoscopy, were categorized as punctate (a diffuse, honeycomb-like appearance, 17 patients) or striped (a linear, watermelon-like appearance, 6 patients).

All GAVE patients with cirrhosis (16/16, 100%) had a punctate pattern by endoscopy, whereas the majority of patients (6/7, 85.7%) without cirrhosis had a striped pattern (P < 0.001). Overt GAVE bleeding (10/23, 43%) was significantly more common in the non-cirrhosis group than in the cirrhosis group (6/7, 85.7% vs 4/16, 25.0%; P = 0.019), and more common in the striped group than in the punctate group (5/6, 83.3% vs 5/17, 29.4%; P = 0.052). However, mean numbers of admissions due to GAVE bleeding and argon plasma coagulation (APC) sessions to address overt bleeding were similar in the cirrhosis and non-cirrhosis groups and in the punctate and striped groups. All patients with GAVE bleeding were successfully treated by APC, and no patient died from GAVE-related blood loss during a median follow-up of 24 mo.

Punctate-type GAVE is strongly associated with liver cirrhosis, and GAVE patients without cirrhosis tend to be more prone to overt bleeding. However, the presence of cirrhosis and endoscopic patterns did not influence long-term clinical courses or outcomes in cases of overt bleeding.

• Gastric antral vascular ectasia
• Cirrhosis
• Endoscopy
• Gastrointestinal bleeding
• Argon plasma coagulation

Accurate detection of gastric antral vascular ectasia (GAVE) is critical for proper management of cirrhosis-related gastrointestinal bleeding. However, endoscopic diagnosis of GAVE can be challenging when GAVE overlaps with severe portal hypertensive gastropathy (PHG).

To determine the added diagnostic value of virtual chromoendoscopy to high definition white light for real-time endoscopic diagnosis of GAVE and PHG.

We developed an I-scan virtual chromoendoscopy criteria for diagnosis of GAVE and PHG. We tested our criteria in a cross-sectional cohort of cirrhotic adults with GAVE and PHG when high-definition white light endoscopy (HDWLE) diagnosis was in doubt. We then compared the accuracy of I-scan vs HDWLE alone to histology.

Twenty-three patients were included in this study (65.2% Caucasians and 60.9% males). Chronic hepatitis C was the predominant cause of cirrhosis (43.5%) and seven adults (30.4%) had confirmed GAVE on histology. I-scan had higher sensitivity (100% vs 85.7%) and specificity (75% vs 62.5%) in diagnosing GAVE compared to HDWLE. This translates into a higher, albeit not statistically significant, accuracy of I-scan in detecting GAVE compared to HDWLE alone (82% vs 70%). I-scan was less likely to lead to an accurate diagnosis of GAVE in patients on dialysis (P < 0.05) and in patients with elevated creatinine (P < 0.05). I-scan had similar accuracy to HDWLE in detecting PHG.

This pilot work supports that virtual chromoendoscopy may obviate the need for biopsies when the presence of GAVE is in doubt. Larger studies are needed to assess the impact of virtual chromoendoscopy on success of endoscopic therapy for GAVE.

• Portal hypertensive gastropathy
• Gastric antral vascular ectasia
• Virtual chromoendoscopy
• Endoscopy

• Argon plasma coagulation
• Endoscopic band ligation
• Endoscopy
• Gastric antral vascular ectasia

• argon plasma coagulation
• endoscopic band ligation
• gastric antral vascular ectasia
• radiofrequency ablation

Gastric antral vascular ectasia (GAVE) is a significant complication of cirrhosis. Numerous medical, surgical, and endoscopic treatment modalities have been proposed with varied satisfactory results. In a few small studies, GAVE and associated anemia have resolved after orthotopic liver transplantation (OLT). 

To assess the impact of OLT on the resolution of GAVE and related anemia.

We retrospectively reviewed clinical records of adult patients with GAVE who underwent OLT between September 2012 and September 2019. Demographics and other relevant clinical findings were collected, including hemoglobin levels and upper endoscopy findings before and after OLT. The primary outcome was the resolution of GAVE and its related anemia after OLT.

Sixteen patients were identified. Mean pre-OLT Hgb was 7.7 g/dL and mean 12 mo post-OLT Hgb was 11.9 g/dL, (P = 0.001). Anemia improved (defined as Hgb increased by 2g) in 87.5% of patients within 6 to 12 mo after OLT and resolved completely in half of the patients. Post-OLT esophagogastroduodenoscopy was performed in 10 patients, and GAVE was found to have resolved entirely in 6 of those patients (60%). 

Although GAVE and associated anemia completely resolved in the majority of our patients after OLT, GAVE persisted in a few patients after transplant. Further studies in a large group of patients are necessary to understand the causality of disease and to better understand the factors associated with the persistence of GAVE post-transplant.

• Liver cirrhosis
• Iron deficiency anemia
• End-stage liver disease
• Gastroscopy
• Gastrointestinal hemorrhage
• Liver transplantation

Gastric antral vascular ectasia (GAVE) is the underlying cause for 4% of nonvariceal upper GI bleeding. Nodular GAVE and gastric hyperplastic polyps have similar appearance on upper GI endoscopy (EGD) as well as histology, which could delay specific targeted therapy. We herein, through this case, would like to highlight that high clinical suspicion is required to diagnose nodular GAVE.

A 70-year-old male with a past medical history significant for coronary artery disease s/p drug-eluting stent placement on Plavix, coronary artery bypass grafting, mechanical aortic valve replacement on warfarin, and iron deficiency anemia on replacement was admitted for the evaluation of fatigue and melena for a month. Physical examination was positive for black stool. The only significant lab was a drop in hemoglobin/hematocrit (Hg/dl/H%) of 10/32 to 4/12.5. Fibrosure was sought which suggested that the patient had an F4 cirrhosis. Endoscopy showed nodules in the gastric antrum which were presumptively treated as GAVE with argon plasma coagulation (APC). Surgical pathology showed reactive gastropathy and gastric polyps. Review of the past histology suggested that because of the overlap in the histopathological features of hyperplastic polyps and GAVE, they were misinterpreted as hyperplastic polyp rather than nodular GAVE.

GAVE can be classified endoscopically as punctate, striped, nodular, or polypoidal form. The light microscopic findings considered specific to GAVE are vascular hyperplasia, mucosal vascular ectasia, intravascular fibrin thrombi, and fibromuscular hyperplasia. However, these findings do not differentiate GAVE from hyperplastic gastric polyp. The first line of treatment for GAVE is endoscopic ablation with Nd:YAG laser or argon plasma coagulation. Response to therapy was seen with a mean of 2.6 treatment sessions. There is not a lot of evidence supportive of pharmacological treatment of GAVE with estrogen-progesterone, tranexamic acid, and thalidomide. Serial endoscopic band ligation as well as detachable snares in the management of nodular GAVE refractory to argon plasma coagulation has also been tried.

Oftentimes, there is a delay in the diagnosis and treatment of nodular GAVE as the histopathological appearance could be similar to gastric polyps. The diagnosis of GAVE especially nodular GAVE requires a high level of clinical suspicion. Misdiagnosis of nodular GAVE can delay targeted therapy and have fatal outcomes.

• GAVE
• NASH
• cirrhosis

• Argon plasma coagulation
• Children
• Endoscopic band ligation
• Gastric antral vascular ectasia
• Portal hypertension

• gastric antral vascular ectasia
• intravenous cyclophosphamide
• systemic sclerosis

• Administration, Intravenous
• Aged
• Cyclophosphamide/administration & dosage
• Female
• Gastric Antral Vascular Ectasia/drug therapy
• Humans
• Immunosuppressive Agents/administration & dosage
• Recurrence
• Scleroderma, Systemic/complications
• Treatment Outcome

• CRP
• Cancer
• EUS
• GAVE

Gastric antral vascular ectasia or “watermelon stomach” is a significant cause of nonvariceal upper GI bleeding and is characterized by red, tortuous ectatic vessels along longitudinal folds in the gastric antrum. The existing literature links GAVE to patients with cirrhosis, scleroderma, bone marrow transplantation, and chronic renal failure among other associations, but its pathophysiology remains ill-defined. Over 30 cases of hematopoietic stem cell transplant-related GAVE (HSCT-GAVE) have been reported in the literature to date and there are likely many more that go undiagnosed or are attributed to another cause of upper gastrointestinal bleeding. Interestingly, a busulfan-containing conditioning regimen has been the primary factor implicated in the etiology of HSCT-GAVE because this was common to all cases in the literature to date. Here, we present the first case of HSCT-GAVE in a patient that was treated with a non-busulfan-containing conditioning regimen. We propose a link between chronic GVHD and the development of HSCT-GAVE that is supported by a similar development of GAVE in patients with systemic sclerosis.

• Cirrhosis
• Gastric nodules
• Gastrointestinal bleeding

• endoscopy
• gastric antral vascular ectasia
• gastrointestinal bleeding

To study and describe patients who underwent treatment for gastric antral vascular ectasia (GAVE) with different endoscopic treatment modalities.

We reviewed patients with GAVE who underwent treatment at University of Alabama at Birmingham between March 1, 2012 and December 31, 2016. Included patients had an endoscopic diagnosis of GAVE with associated upper gastrointestinal bleeding or iron deficiency anemia.

Seven out of 15 patients had classic watermelon description for GAVE, 1/15 with diffuse/honeycomb pattern and 6/15 with nodular GAVE per EGD description. Seven out of 15 patients required multimodal treatment. Four out of six of patients with endoscopically nodular GAVE required multimodal therapy. Overall, mean pre- and post-treatment hemoglobin (Hb) values were 8.2 ± 0.8 g/dL and 9.7 ± 1.6 g/dL, respectively (P ≤ 0.05). Mean number of packed red blood cells transfusions before and after treatment was 3.8 ± 4.3 and 1.2 ± 1.7 (P ≤ 0.05), respectively.

Patients with nodular variant GAVE required multimodal approach more frequently than non-nodular variants. Patients responded well to multimodal therapy and saw decrease in transfusion rates and increase in Hb concentrations. Our findings suggest a multimodal approach may be beneficial in nodular variant GAVE.

• Gastric antral vascular ectasia
• Upper GI bleed
• Radiofrequency ablation
• Endoscopic band ligation
• Argon plasma coagulation

• ESRD
• GAVE
• end-stage renal disease
• gastric antral vascular ectasia
• hemodialysis
• watermelon stomach

• Adult
• Alabama
• Anemia/blood
• Anemia/diagnosis
• Anemia/etiology
• Biomarkers/blood
• Endoscopy, Digestive System
• Female
• Gastric Antral Vascular Ectasia/diagnosis
• Gastric Antral Vascular Ectasia/etiology
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Hemoglobins/metabolism
• Humans
• Immunosuppressive Agents/therapeutic use
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis
• Liver Cirrhosis/surgery
• Liver Transplantation
• Male
• Middle Aged
• Retrospective Studies
• Time Factors
• Treatment Outcome

• Endoscopy
• Gastric antral vascular ectasia
• Gastrointestinal bleeding
• Stomach

• gastric antral vascular ectasia
• gastrointestinal tract involvement
• systemic sclerosis

• Argon Plasma Coagulation
• Endoscopy Gastrointestinal
• Gastric Antral Vascular Ectasia
• Ligation

• Endoscopic Hemostasis
• Endoscopic Ultrasound
• Lower Intestinal Bleeding
• Upper Gastrointestinal Bleeding

• Endoscopy
• Gastric antral vascular ectasia
• Liver disease
• Portal hypertension

• T32 DK007769 NIDDK NIH HHS

Introduction. Gastric antral vascular ectasia (GAVE) is a rare entity with unique endoscopic appearance described as “watermelon stomach.” It has been associated with systemic sclerosis but the pathophysiological changes leading to GAVE have not been explained and still remain uncertain. Methods. Databases Medline, Scopus, Embase, PubMed, and Cochrane were searched for relevant papers. The main search words were “Gastric antral vascular ectasia,” “Watermelon Stomach,” “GAVE,” “Scleroderma,” and “Systemic Sclerosis.” Fifty-four papers were considered for this review. Results. GAVE is a rare entity in the spectrum of manifestations of systemic sclerosis with unknown pathogenesis. Most patients with systemic sclerosis and GAVE present with asymptomatic anemia, iron deficiency anemia, or heavy acute gastrointestinal bleeding. Symptomatic therapy and endoscopic ablation are the first-line of treatment. Surgical approach may be recommended for patients who do not respond to medical or endoscopic therapies. Conclusion. GAVE can be properly diagnosed and treated. Early diagnosis is key in the management of GAVE because it makes symptomatic therapies and endoscopic approaches feasible. A high index of suspicion is critical. Future studies and a critical review of the current findings about GAVE are needed to understand the role of this condition in systemic sclerosis.

• Ampullary carcinoma
• Aortoenteric fistula
• Cameron lesions
• Dieulafoy lesions
• Duodenal varices
• Gastric antral vascular ectasia
• Hemobilia
• Hemosuccus pancreaticus

• GI bleeding
• Liver cirrhosis
• Portal hypertension
• Transjugular intrahepatic portosystemic shunt (TIPS)

Endoscopic ultrasound (EUS) has revolutionized the diagnostic and therapeutic approach to patients with gastrointestinal disorders. Its application in patients with liver disease and portal hypertension is increasing. Patients with chronic liver disease are at risk for development of portal hypertension sequale such as ascites, spontaneous bacterial peritonitis and gastroesophageal varices. Bleeding esophageal and gastric varices are among the most common causes of mortality in patients with cirrhosis. Thus, early detection and treatment improve the outcome in this population. EUS can improve the detection and diagnosis of gastroesophageal varices and collateral veins and can provide endoscopic therapy of gastroesophageal varices such as EUS-guided sclerotherapy of esophageal collateral vessels and EUS-guided cynoacrylate (Glue) injection of gastric varices. EUS can also provide knowledge on the efficacy of pharmacotherapy of portal hypertension. Furthermore, EUS can provide assessment and prediction of variceal recurrence after endoscopic therapy and assessment of portal hemodynamics such as E-Flow and Doppler study of the azygous and portal veins. Moreover, EUS-guided fine needle aspiration may provide cytologic diagnosis of focal hepatic tumors and analysis of free abdominal fluid. Using specialized EUS-guided needle biopsy, a sample of liver tissue can be obtained to diagnose and evaluate for chronic liver disease. EUS-guided fine needle injection can be used to study portal vein pressure and hemodynamics, and potentially could be used to assist in exact measurement of portal vein pressure and placement of intrahepatic portosystemic shunt.

• Endoscopic ultrasound
• Cirrhosis
• Portal hypertension
• Gastroesophageal varices
• Cyanoacrylate
• Hepatocellular carcinoma
• Fine needle aspiration

• Ascites/diagnostic imaging
• Ascites/etiology
• Cyanoacrylates/administration & dosage
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Endosonography
• Esophageal and Gastric Varices/diagnostic imaging
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/therapy
• Gastrointestinal Hemorrhage/diagnostic imaging
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Hypertension, Portal/complications
• Hypertension, Portal/diagnostic imaging
• Hypertension, Portal/physiopathology
• Hypertension, Portal/therapy
• Injections
• Portal Pressure
• Portal Vein/diagnostic imaging
• Portal Vein/physiopathology
• Portasystemic Shunt, Surgical/methods
• Predictive Value of Tests
• Recurrence
• Sclerosing Solutions/administration & dosage
• Sclerotherapy/methods
• Treatment Outcome
• Ultrasonography, Doppler
• Ultrasonography, Interventional/methods

• APC
• CS
• GAVE
• RFA
• argon plasma coagulation
• clinical success
• gastric antral vascular ectasia
• radiofrequency ablation

• argon plasma coagulation (APC)
• endoscopic band ligation
• gastric antral vascular ectasia (GAVE)
• watermelon stomach

• Endoscopy
• GAVE
• Gastric antral vascular ectasia
• Gastrointestinal bleeding

• Aged
• Argon Plasma Coagulation
• Blood Transfusion
• Disease Management
• Endoscopy, Gastrointestinal
• Female
• Gastric Antral Vascular Ectasia/diagnosis
• Gastric Antral Vascular Ectasia/pathology
• Gastric Antral Vascular Ectasia/therapy
• Humans
• Male
• Middle Aged
• Recurrence
• Treatment Outcome

Gastric antral vascular ectasia (GAVE) is an uncommon but often severe cause of upper gastrointestinal (GI) bleeding, responsible of about 4% of non-variceal upper GI haemorrhage. The diagnosis is mainly based on endoscopic pattern and, for uncertain cases, on histology. GAVE is characterized by a pathognomonic endoscopic pattern, mainly represented by red spots either organized in stripes radially departing from pylorus, defined as watermelon stomach, or arranged in a diffused-way, the so called honeycomb stomach. The histological pattern, although not pathognomonic, is characterized by four alterations: vascular ectasia of mucosal capillaries, focal thrombosis, spindle cell proliferation and fibrohyalinosis, which consist of homogeneous substance around the ectatic capillaries of the lamina propria. The main differential diagnosis is with Portal Hypertensive Gastropathy, that can frequently co-exists, since about 30% of patients with GAVE co-present a liver cirrhosis. Autoimmune disorders, mainly represented by Reynaud’s phenomenon and sclerodactyly, are co-present in about 60% of patients with GAVE; other autoimmune and connective tissue disorders are occasionally reported such as Sjogren’s syndrome, systemic lupus erythematosus, primary biliary cirrhosis and systemic sclerosis. In the remaining cases, GAVE syndrome has been described in patients with chronic renal failure, bone marrow transplantation and cardiac diseases. The pathogenesis of GAVE is still obscure and many hypotheses have been proposed such as mechanical stress, humoural and autoimmune factors and hemodynamic alterations. In the last two decades, many therapeutic options have been proposed including surgical, endoscopic and medical choices. Medical therapy has not clearly shown satisfactory results and surgery should only be considered for refractory severe cases, since this approach has significant mortality and morbidity risks, especially in the setting of portal hypertension and liver cirrhosis. Endoscopic therapy, particularly treatment with Argon Plasma Coagulation, has shown to be as effective and also safer than surgery, and should be considered the first-line treatment for patients with GAVE-related bleeding.

• Gastric antral vascular ectasia
• Bleeding
• Watermelon stomach
• Argon plasma coagulation

• endoscopic argon plasma coagulation
• angiodysplasia
• gastric antral vascular ectasia

• Aged
• Aged, 80 and over
• Angiodysplasia/complications
• Angiodysplasia/surgery
• Argon Plasma Coagulation/adverse effects
• Argon Plasma Coagulation/methods
• Endoscopy, Gastrointestinal/adverse effects
• Endoscopy, Gastrointestinal/methods
• Female
• Follow-Up Studies
• Gastric Antral Vascular Ectasia/complications
• Gastric Antral Vascular Ectasia/surgery
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/mortality
• Gastrointestinal Hemorrhage/surgery
• Hemostasis, Endoscopic/adverse effects
• Hemostasis, Endoscopic/methods
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Recurrence
• Retrospective Studies
• Risk Factors
• Survival Rate
• Treatment Outcome
• Upper Gastrointestinal Tract/blood supply