• Endoscopic management
• Gastrointestinal bleeding
• Iron deficiency anemia
• Liver cirrhosis
• Portal hypertension

• Humans
• Gastric Antral Vascular Ectasia/complications
• Gastric Antral Vascular Ectasia/diagnosis
• Gastric Antral Vascular Ectasia/therapy
• Stomach Diseases/complications
• Stomach Diseases/diagnosis
• Hypertension, Portal/complications
• Endoscopy, Gastrointestinal/adverse effects
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy

• Argon plasma coagulation (APC)
• gastroesophageal reflux disease (GERD)
• innovation
• minimally invasive procedure
• thermal ablation

• argon plasma coagulation
• diffuse antral vascular ectasia
• distal gastrectomy
• gastric antral vascular ectasia
• upper gastrointestinal(ugi) bleeding

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) 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

• BRTO
• Cirrhosis
• Early TIPS
• Endoscopy
• Esophageal varices
• Gastric varices
• Gastrointestinal bleeding
• Portal hypertension
• Primary prophylaxis
• Secondary prophylaxis

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

• Anemia, iron-deficiency
• Argon plasma coagulation
• Endoscopic band ligation
• Gastric antral vascular ectasia
• Retrospective study

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.

• 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

• Ablation
• cryotherapy
• gastrointestinal bleeding
• watermelon stomach

• Cirrhosis
• Gastric antral vascular ectasia
• Gastrointestinal bleeding
• Therapeutic endoscopy
• Varices

GAVE is an uncommon cause of upper nonvariceal bleeding and often manifests itself as occult bleeding with chronic anemia. To date, the standard of care for GAVE is endoscopic treatment with thermoablative techniques. Despite good technical results, approximately two thirds of patients remain dependent on transfusions after the therapy. One of the emerging and more promising endoscopic treatments for GAVE is radiofrequency ablation (RFA). The aim of this study is to perform a systematic review of literature in order to assess current evidence supporting the effectiveness of this technique for treatment of refractory GAVE.

Through electronic search, we identified 14 records, and after removal of duplicates and irrelevant studies, we selected 10 studies on radiofrequency ablation of GAVE: 4 prospective open-label single-center studies, 1 retrospective multicentric study, and 5 case reports.

Among all 72 treated patients reported in literature, 74.3% achieved a clinical response, while nonfatal AEs have been reported in 4.2% of cases.

Despite some qualitative limitations, all literature data support effectiveness of RFA for treatment of refractory GAVE. In the future, large prospective controlled trials with adequate follow-up are needed to better assess the effectiveness and safety of this procedure.

To evaluate long-term endoscopic resolution and recurrence rate of gastric antral vascular ectasia (GAVE) after argon plasma coagulation (APC) treatment.

This was an IRB-approved retrospective single center study that included patients endoscopically treated for GAVE between 1/1/2008 to 12/31/2014. The primary and secondary end points of the study were rate of endoscopic resolution of GAVE after APC treatment and recurrence rate of GAVE after endoscopic resolution, respectively. Endoscopic resolution of GAVE was defined as no endoscopic evidence of GAVE after treatment with APC. Recurrence of GAVE was defined as endoscopic reappearance of GAVE after prior resolution.

Twenty patients met the study criteria. Median age (range) of the patients was 59.5 years (42-74 years). GAVE was associated with underlying cirrhosis in 16 (80%) patients. Indications for initial esophagogastroduodenoscopy (EGD) included hematemesis and/or melena (9/20, 45%), iron deficiency anemia (6/20, 30%), screening or surveillance of varices (4/20, 20%), and occult gastrointestinal bleeding (1/20, 5%). The patients were treated with a total of 55 APC sessions (range 1-7 sessions). Successful endoscopic resolution of GAVE was achieved in 8 out of 20 patients (40%). There was no correlation between number of treatment sessions and GAVE treatment success (P = NS). Recurrence of GAVE was noted on a subsequent EGD in 2 out of 8 patients (25%) with prior endoscopic resolution of GAVE. Median follow-up period for the study population was 627 d (range 63-1953 d).

Endoscopic resolution rate of GAVE was low (40%) with a 25% recurrence rate after treatment with APC. These rates suggest that APC treatment of GAVE may not be optimal in many circumstances.

• Gastric antral vascular ectasia
• Argon plasma coagulation

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

• Chronic GI bleeding
• Ectasia
• Gastric antral vascular
• Vascular-targeted photodynamic therapy

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

• 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.

• Radiofrequency
• biliary strictures
• esophageal neoplasia
• gastrointestinal bleeding
• radiation proctopathy

• Angiodysplasia
• Comparison Analysis
• Gastric Antral Vascular Ectasia
• Systematic Review

• GAVE
• RNA POLYMERASE III
• SCLERODERMA RENAL CRISIS
• SYSTEMIC SCLEROSIS
• WATERMELON STOMACH

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

Bleeding from esophageal varices is a life threatening complication of portal hypertension. Primary prevention of bleeding in patients at risk for a first bleeding episode is therefore a major goal. Medical prophylaxis consists of non-selective beta-blockers like propranolol or carvedilol. Variceal endoscopic band ligation is equally effective but procedure related morbidity is a drawback of the method. Therapy of acute bleeding is based on three strategies: vasopressor drugs like terlipressin, antibiotics and endoscopic therapy. In refractory bleeding, self-expandable stents offer an option for bridging to definite treatments like transjugular intrahepatic portosystemic shunt (TIPS). Treatment of bleeding from gastric varices depends on vasopressor drugs and on injection of varices with cyanoacrylate. Strategies for primary or secondary prevention are based on non-selective beta-blockers but data from large clinical trials is lacking. Therapy of refractory bleeding relies on shunt-procedures like TIPS. Bleeding from ectopic varices, portal hypertensive gastropathy and gastric antral vascular ectasia-syndrome is less common. Possible medical and endoscopic treatment options are discussed.

• Portal hypertension
• Esophageal varices
• Gastric varices
• Portal hypertensive gastropathy
• Gastric antral vascular ectasia-syndrome
• Variceal bleeding
• Endoscopy
• Band ligation
• Beta-blocker

• Adrenergic beta-Antagonists/therapeutic use
• Anti-Bacterial Agents/therapeutic use
• Endoscopy
• Esophageal and Gastric Varices/diagnosis
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/prevention & control
• Esophageal and Gastric Varices/therapy
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/prevention & control
• Gastrointestinal Hemorrhage/therapy
• Hemostasis, Endoscopic
• Humans
• Hypertension, Portal/complications
• Hypertension, Portal/diagnosis
• Hypertension, Portal/therapy
• Ligation
• Portasystemic Shunt, Transjugular Intrahepatic
• Stents
• Treatment Outcome
• Vasoconstrictor Agents/therapeutic use

Gastric antral vascular ectasia (GAVE) and its nodular antral gastropathy (NAG) variant is a unique lesion associated with hypergastrinemic hormonal alterations that may be compounded by concurrent proton pump inhibitor (PPI) therapy. The use of octreotide as a somatostatin analogue and its role in the down regulation of variousenteric hormones has been well documented however its use in the management of NAG has not been widely reported. We herein present a case where octreotide induced gastrin down-regulation as well as PPI cessation facilitated NAG resolution.

• Gastric antral vascular ectasia
• Nodular antral gastropathy
• Proton pump inhibitor

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

Gastric antral vascular ectasia is a not so well-understood, and more rare, gastrointestinal manifestation of Systemic Sclerosis which can lead to chronic anemia. A high suspicion and better understanding of this rare manifestation is needed for early detection and treatment. Therapeutic regiments include iron supplementation with acid suppressive therapy, while endoscopic intervention has been shown to be successful in most cases, with gastrectomy or antrectomy rarely needed.

AIM: To evaluate the application value of Phloroglucinol for Injection in special endoscopic treatment for esophageal diseases, such as narrow-band imaging (NBI) magnifying endoscopy, endoscopic ultrasonography (EUS) and argon plasma coagulation therapy.

METHODS: Ninety patients who were willing to accept NBI magnifying endoscopy, EUS or argon plasma coagulation therapy for esophageal diseases (e.g., Barrett's esophagus or early esophageal cancer) were randomly divided into two groups, one using phloroglucinol and the other using 654-2. The frequency of esophagism, operating time and side effects were compared between the two groups.

RESULTS: Compared to the 654-2 group, the frequency of esophagism was significantly lower (1.45 c.p.m ± 0.68 c.p.m vs 2.88 c.p.m ± 1.48 c.p.m, P < 0.01) and the operating time was significantly shorter (174.77 s ± 48.63 s vs 225.00 s ± 59.48 s, P < 0.01) in the phloroglucinol group. Patients of the 654-2 group developed adverse side effects such as dry mouth (5 cases), transient urinary retention (2 cases) and obviously increased heart rate, while patients of the phloroglucinol groups did not.

CONCLUSION: Phloroglucinol is likely capable of effectively relieving esophagism and shortening the operating time in special endoscopic treatment for esophageal diseases and causes no adverse side effects like increased heart rate, dry mouth and urinary retention.

• Phloroglucinol
• Anisodamine hydrobromide
• Endoscopic ultrasonography
• Narrow-brand imaging endoscopy

• Argon Plasma Coagulation
• Diagnosis, Differential
• Gastric Antral Vascular Ectasia/diagnosis
• Gastric Antral Vascular Ectasia/etiology
• Gastric Antral Vascular Ectasia/physiopathology
• Gastric Antral Vascular Ectasia/surgery
• Gastrointestinal Hemorrhage/drug therapy
• Gastrointestinal Hemorrhage/etiology
• Humans
• Hypertension, Portal/complications
• Hypertension, Portal/drug therapy
• Hypertension, Portal/etiology
• Liver Cirrhosis/complications
• Stomach Diseases/diagnosis
• Stomach Diseases/drug therapy
• Stomach Diseases/etiology
• Stomach Diseases/physiopathology

• P30 DK34989 NIDDK NIH HHS

• Argon plasma coagulation
• Endoscopic band ligation
• Gastric antral vascular ectasia
• Liver cirrhosis

An 80-year-old woman was admitted to our hospital because of tarry stool with iron deficiency anemia. Her past history included autoimmune hepatitis. Esophagogastroduodenal endoscopy was performed to investigate the bleeding source and revealed multiple linear gastric vascular malformations in the antrum and cardia, compatible with Gastric antral vascular ectasia (GAVE). Endoscopic ablation was carried out with the tip of the hot biopsy forceps without opening at soft coagulation mode of 80W. The patient tolerated the procedure well and there were no complications associated with endoscopic therapies. After two sessions of endoscopic ablation her anemia improved to around 10 g/dL, an increase of 3.6 g/dL. Various endoscopic treatments have been described to manage GAVE. The most popular is argon plasma coagulation (APC), although APC is associated with over-distension induced by the argon plasma gas. To avoid over-distension and to reduce the abdominal discomfort/pain of this patient, we have used hot biopsy forceps instead of APC. Our case suggests that this procedure is effective, easy and convenient, as no special equipment or skill is necessary.

• Hot biopsy forceps
• Endoscopic ablation
• Gastric antral vascular ectasia