Gastric antral vascular ectasia (GAVE) or watermelon stomach is an uncommon but important cause of gastrointestinal bleeding and anemia, first described in 1953 by Rider et al (1). GAVE is characterized by a “characteristic” endoscopic pattern, mainly represented by red spots either organized in stripes radially departing from pylorus (“watermelon stomach”, or arranged in a diffused-way or “honeycomb stomach”). In addition, there is a nodular variety, where there are multiple enlarged and nodular folds in the antrum (2, 3). Despite this GAVE is often misclassified or mis-diagnosed.

Histology shows dilation of mucosal capillaries, with focal thrombosis and fibromuscular hyperplasia of the lamina propria and thickened mucosa with tortuous submucosal venous channels. A scoring system known as the “Gilliam score” was created to aid in histologic diagnosis of GAVE. This scoring system focuses on the following criteria: spindle cell proliferation presenting with either ectasia, fibrin thrombi, or a combination of both ectasia and fibrin thrombi (4). Payen et al., further, expanded this scoring system to include fibro-hyalinosis as a third diagnostic criteria for GAVE. This more robust score was referred to as the “GAVE score” (5).

The exact cause of GAVE is not known. GAVE or watermelon stomach is often associated with a number of conditions, including portal hypertension, cirrhosis, hypergastrinemia, metabolic syndrome, chronic renal failure, collagen vascular diseases, scleroderma, systemic lupus erythematosus, Sjögren’s disease, primary biliary cholangitis, bone marrow transplantation, pernicious anemia, and as shown by our group, heart failure with left ventricular assist device (LVAD) with development of Heyde syndrome (6).

Treatment of GAVE is aimed at obliterating all the vessels and can be accomplished by argon plasma coagulation, radiofrequency ablation and endoscopic band ligation.

Visit endocollab.com for Quick Tip Videos on how to treat GAVE with APC, RFA or endoscopic band ligation (2,3).

Read More on Gastric Antral Vascular Ectasia (GAVE) on EndoCollab

• What Are the Etiologies of Watermelon Stomach (GAVE, Gastric Antral Vascular Ectasia)? [Link]

• GAVE Characteristics [Link]

• Nodular gastric antral vascular ectasia (GAVE) [Link]

• GAVE in patient with cirrhosis [Link]

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References:

1.    Rider JA, Klotz AP, Kirsner JB: Gastritis with veno-capillary ectasia as a source of massive gastric hemorrhage. Gastroenterol 1953;24: 118–123.

2.    Fuccio L, Mussetto A, Laterza L, et al. Diagnosis and management of gastric antral vascular ectasia. World J Gastrointest Endosc. 2013;5:6-13.

3.    Aryan M, Jariwala R, Alkurdi B, Peter S, Shoreibah M. The misclassification of gastric antral vascular ectasia. J Clin Transl Res. 2022 May 25;8(3):218-223.

4.    Gilliam JH, Geisinger KR, Wu WC, Weidner N, Richter JE. Endoscopic Biopsy is Diagnostic in Gastric Antral Vascular Ectasia. Dig Dis Sci. 1989;34:885–8.

5.    Payen JL, Calès P, Voigt JJ, Barbe S, Pilette C, Dubuisson L, et al. Severe Portal Hypertensive Gastropathy and Antral Vascular Ectasia are Distinct Entities in Patients with Cirrhosis. Gastroenterology. 1995;108:866–72.

6.    Alkurdi B, Mönkemüller K, Khan AS, Council L, McGuire BM, Peter S. Gastric antral vascular ectasia: a rare manifestation for gastrointestinal bleeding in left ventricular assist device patients--an initial report. Dig Dis Sci. 2014 Nov;59(11):2826-30.