Endoscopic band ligation or urgent surgery both can be successful in the treatment of the watermelon stomach causing severe GI bleeding

Introduction: Gastric antral vascular ectasia (GAVE) so called watermelon stomach is characterized by mucosal and submucosal vascular ectasia causing recurrent GI hemorrhage. About a third of the cases are associated with portal hypertension. In majority of cases it can be presented as anemia due to occult blood loss, while massive GI bleeding is rare. GAVE can be treated with medical, endoscopic, and surgical approaches. Patients and methods: Last year we treated two patients with severe GI bleeding caused by GAVE. Case1. A 66 years old male with suspected portal hypertension was referred for iron deficiency anemia. Several colorectal polyps were removed, but the anemia did not improved. Gastroscopy revealed GAVE with relatively still endoscopic appearance at the beginning. In the first month he needed in sum 9 units of blood transfusion, but in the second month it increased to 31, and the endoscopic appearance became more and more severe. Finally we had to perform urgent gastric resection due to uncontrollable bleeding from GAVE. The patient recovered after surgery and the bleeding did not recur. Case 2– A 60 years old male was referred to us after transfusion of 18 units of blood in the last 4 months. Former evaluations could not reveal the source of the blood loss. Gastroscopy showed GAVE. It's endoscopic appearance became more severe at the repeated gastroscopy, therefore we decided to perform endoscopic band ligation to prevent further worsening and to avoid surgery. Twelve ligation band was placed on the affected antral mucosa. The cessation of blood loss occurred with partial resolution of the watermelon stomach. We continued elective band ligation until complete resolution of the GAVE. Conclusion: Endoscopic band ligation of the bleeding watermelon stomach can be an alternative, successful treatment modality to surgical resection.