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Endosc Int Open 2014; 02(02): E67-E73
DOI: 10.1055/s-0034-1365525
Review
© Georg Thieme Verlag KG Stuttgart · New York

Gastric antral vascular ectasia: the evolution of therapeutic modalities

Harini Naidu
1   Department of Internal Medicine, Boston University Medical Center, Boston, Massachusetts, United States
,
Qin Huang
2   Department of Gastroenterology, VA Boston Healthcare System, Boston, Massachusetts, United States
3   Department of Pathology, Harvard Medical School, Boston, Massachusetts, United States
,
Hiroshi Mashimo
2   Department of Gastroenterology, VA Boston Healthcare System, Boston, Massachusetts, United States
3   Department of Pathology, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations
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Publication History

submitted 10 July 2013

accepted after revision 08 January 2014

Publication Date:
15 May 2014 (online)

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Endoscopy International OpenEndoscopy 2014; 46(07): 630-630
DOI: 10.1055/s-0034-1367628

Gastric Antral Vascular Ectasia (GAVE) may be an enigmatic source of non-variceal upper GI bleeding associated with various systemic diseases such as connective tissue disorders, liver disease, and chronic renal failure. Successful treatment of GAVE continues to be a challenge and has evolved through the years. Currently, given the rapid response, safety, and efficacy, endoscopic ablative modalities have largely usurped medical treatments as first-line therapy, particularly using argon plasma coagulation. However, other newer ablative modalities such as radiofrequency ablation, cryotherapy, and band ligations are promising. This paper is an overview of GAVE and its various endoscopic and medical therapies.

 

  • References

  • 1 Rider JA, Klotz AP, Kirsner JB. Gastritis with veno-capillary ectasia as a source of massive gastric hemorrhage. Gastroenterology 1953; 24: 118-123
    CrossrefPubMedSearch in Google Scholar
  • 2 Jabbari M, Cherry R, Lough JO et al. Gastric antral vascular ectasia: the watermelon stomach. Gastroenterology 1984; 87: 1165-1170
    CrossrefPubMedSearch in Google Scholar
  • 3 Stotzer PO, Willén R, Kilander AF. Watermelon stomach: not only an antral disease. Gastrointest Endosc 2002; 55: 897-900
    CrossrefPubMedSearch in Google Scholar
  • 4 Gilliam III JH, Geisinger KR, Wu WC et al. Endoscopic biopsy is diagnostic in gastric antral vascular ectasia. The “watermelon stomach”. Dig Dis Sci 1989; 34: 885-888
    CrossrefPubMedSearch in Google Scholar
  • 5 Payen JL, Calès P, Voigt JJ et al. Severe portal hypertensive gastropathy and antral vascular ectasia are distinct entities in patients with cirrhosis. Gastroenterology 1995; 108: 138-144
    CrossrefPubMedSearch in Google Scholar
  • 6 Westerhoff M, Tretiakova M, Hovan L et al. CD61, CD31, and CD34 improve diagnostic accuracy in gastric antral vascular ectasia and portal hypertensive gastropathy: An immunohistochemical and digital morphometric study. Am J Surg Pathol 2010; 34: 494-501
    CrossrefPubMedSearch in Google Scholar
  • 7 Burak KW, Lee SS, Beck PL. Portal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) syndrome. Gut 2001; 49: 866-872
    CrossrefPubMedSearch in Google Scholar
  • 8 Saperas E, Perez Ayuso RM, Poca E et al. Increased gastric PGE2 biosynthesis in cirrhotic patients with gastric vascular ectasia. Am J Gastroenterol 1990; 85: 138-144
    PubMedSearch in Google Scholar
  • 9 Hung EW, Mayes MD, Sharif R et al. Gastric antral vascular ectasia and its clinical correlates in patients with early diffuse systemic sclerosis in the SCOT trial. J Rheumatol 2013; 40: 455-460
    CrossrefPubMedSearch in Google Scholar
  • 10 Ceribelli A, Cavazzana I, Airò P et al. Anti-RNA polymerase III antibodies as a risk marker for early gastric antral vascular ectasia (GAVE) in systemic sclerosis. J Rheumatol 2010; 37: 1544
    PubMedSearch in Google Scholar
  • 11 Valdez BC, Henning D, Busch RK et al. A nucleolar RNA helicase recognized by autoimmune antibodies from a patient with watermelon stomach disease. Nucleic Acids Res 1996; 24: 1220-1224
    CrossrefPubMedSearch in Google Scholar
  • 12 Garcia MC, Zhou J, Henning D et al. Unique epitopes in RNA helicase II/Gu protein recognized by serum from a watermelon stomach patient. Mol Immunol 2000; 37: 351-359
    CrossrefPubMedSearch in Google Scholar
  • 13 Sallam H, McNearney TA, Chen JD. Systematic review: pathophysiology and management of gastrointestinal dysmotility in systemic sclerosis (scleroderma). Aliment Pharmacol Ther 2006; 23: 691-712
    CrossrefPubMedSearch in Google Scholar
  • 14 Lowes JR, Rode J. Neuroendocrine cell proliferations in gastric antral vascular ectasia. Gastroenterology 1989; 97: 207-212
    PubMedSearch in Google Scholar
  • 15 Ripoll C, Garcia-Tsao G. The management of portal hypertensive gastropathy and gastric antral vascular ectasia. Dig Liver Dis 2011; 43: 345-351
    CrossrefPubMedSearch in Google Scholar
  • 16 Yew BS, Ng KY, Ang DS et al. Gastric antral vascular ectasia successfully controlled by argon plasma coagulation. Ann Acad Med Singapore 2007; 36: 702-703
    PubMedSearch in Google Scholar
  • 17 Yusoff I, Brennan F, Ormonde D et al. Argon plasma coagulation for treatment of watermelon stomach. Endoscopy 2002; 34: 407-410
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Herrera S, Bordas JM, Llach J et al. The beneficial effects of argon plasma coagulation in the management of different types of gastric vascular ectasia lesions in patients admitted for GI hemorrhage. Gastrointest Endosc 2008; 68: 440-446
    CrossrefPubMedSearch in Google Scholar
  • 19 Kwan V, Bourke MJ, Williams SJ et al. Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up. Am J Gastroenterol 2006; 101: 58-63
    CrossrefPubMedSearch in Google Scholar
  • 20 Chiu YC, Lu LS, Wu KL et al. Comparison of argon plasma coagulation in management of upper gastrointestinal angiodysplasia and gastric antral vascular ectasia hemorrhage. BMC Gastroenterol 2012; 12: 67
    CrossrefPubMedSearch in Google Scholar
  • 21 Sebastian S, McLoughlin R, Qasim A et al. Endoscopic argon plasma coagulation for the treatment of gastric antral vascular ectasia (watermelon stomach): long-term results. Dig Liver Dis 2004; 36: 212-217
    CrossrefPubMedSearch in Google Scholar
  • 22 Bhatti MA, Khan AA, Alam A et al. Efficacy of argon plasma coagulation in gastric vascular ectasia in patients with liver cirrhosis. J Coll Physicians Surg Pak 2009; 19: 219-222
    PubMedSearch in Google Scholar
  • 23 Lecleire S, Ben-Soussan E, Antonietti M et al. Bleeding gastric vascular ectasia treated by argon plasma coagulation: a comparison between patients with and without cirrhosis. Gastrointest Endosc 2008; 67: 219-225
    CrossrefPubMedSearch in Google Scholar
  • 24 Naga M, Esmat S, Naguib M et al. Long-term effect of argon plasma coagulation (APC) in the treatment of gastric antral vascular ectasia (GAVE). Arab J Gastroenterol 2011; 12: 40-43
    CrossrefPubMedSearch in Google Scholar
  • 25 Probst A, Scheubel R, Wienbeck M. Treatment of watermelon stomach (GAVE syndrome) by means of endoscopic argon plasma coagulation (APC): long-term outcome. Z Gastroenterol 2001; 39: 447-452
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Chaves DM, Sakai P, Oliveira CV et al. Watermelon stomach: clinical aspects and treatment with argon plasma coagulation. Arq Gastroenterol 2006; 43: 191-195
    CrossrefPubMedSearch in Google Scholar
  • 27 Nakamura S, Mitsunaga A, Konishi H et al. Long-term follow up of gastric antral vascular ectasia treated by argon plasma coagulation. Dig Endosc 2006; 18: 128-133
    CrossrefPubMedSearch in Google Scholar
  • 28 Shibukawa G, Irisawa A, Sakamoto N et al. Gastric antral vascular ectasia (GAVE) associated with systemic sclerosis: relapse after endoscopic treatment by argon plasma coagulation. Intern Med 2007; 46: 279-283
    CrossrefPubMedSearch in Google Scholar
  • 29 Roman S, Saurin JC, Dumortier J et al. Tolerance and efficacy of argon plasma coagulation for controlling bleeding in patients with typical and atypical manifestations of watermelon stomach. Endoscopy 2003; 35: 1024-1028
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Farooq FT, Wong RC, Yang P et al. Gastric outlet obstruction as a complication of argon plasma coagulation for watermelon stomach. Gastrointest Endosc 2007; 65: 1090-1092
    CrossrefPubMedSearch in Google Scholar
  • 31 Fuccio L, Zagari RM, Serrani M et al. Endoscopic argon plasma coagulation for the treatment of gastric antral vascular ectasia-related bleeding in patients with liver cirrhosis. Digestion 2009; 79: 143-150
    CrossrefPubMedSearch in Google Scholar
  • 32 Baudet JS, Salata H, Soler M et al. Hyperplastic gastric polyps after argon plasma coagulation treatment of gastric antral vascular ectasia (GAVE). Endoscopy 2007; 39: E320
    Thieme ConnectPubMedSearch in Google Scholar
  • 33 Rosenfeld G, Enns R. Argon photocoagulation in the treatment of gastric antral vascular ectasia and radiation proctitis. Can J Gastroenterol 2009; 23: 801-804
    PubMedSearch in Google Scholar
  • 34 Muguruma N, Okamoto K, Kimura T et al. Endoscopic ablation therapy for gastrointestinal superficial neoplasia. Dig Endosc 2012; 24: 139-149
    CrossrefPubMedSearch in Google Scholar
  • 35 Zhou C, Adler DC, Becker L et al. Effective treatment of chronic radiation proctitis using radiofrequency ablation. Therap Adv Gastroenterol 2009; 2: 149-156
    CrossrefPubMedSearch in Google Scholar
  • 36 Rustagi T, Mashimo H. Endoscopic management of chronic radiation proctitis. World J Gastroenterol 2011; 17: 4554-4562
    CrossrefPubMedSearch in Google Scholar
  • 37 Gross SA, Al-Haddad M, Gill KR et al. Endoscopic mucosal ablation for the treatment of gastric antral vascular ectasia with the HALO90 system: a pilot study. Gastrointest Endosc 2008; 67: 324-327
    CrossrefPubMedSearch in Google Scholar
  • 38 McGorisk T, Krishnan K, Keefer L et al. Radiofrequency ablation for refractory gastric antral vascular ectasia (with video). Gastrointest Endosc 2013; 78: 584-588
    CrossrefPubMedSearch in Google Scholar
  • 39 Dray X, Repici A, Gonzalez P et al. 1040 Radiofrequency Ablation Treatment of Gastric Antral Vascular Ectasia: Results From an International Collaborative Study. Gastrointest Endosc 2013; 77: AB180
    PubMedSearch in Google Scholar
  • 40 Wells CD, Harrison ME, Gurudu SR et al. Treatment of gastric antral vascular ectasia (watermelon stomach) with endoscopic band ligation. Gastrointest Endosc 2008; 68: 231-236
    CrossrefPubMedSearch in Google Scholar
  • 41 Sato T, Yamazaki K, Akaike J. Endoscopic band ligation versus argon plasma coagulation for gastric antral vascular ectasia associated with liver diseases. Dig Endosc 2012; 24: 237-242
    CrossrefPubMedSearch in Google Scholar
  • 42 Rodriguez SA, Douglas G. American Society for Gastrointestinal Endoscopy Technology Committee. Mucosal ablation devices. Gastrointest Endosc 2008; 68: 1031-1042
    CrossrefPubMedSearch in Google Scholar
  • 43 Mathou NG, Lovat LB, Thorpe SM et al. Nd:YAG laser induces long-term remission in transfusion-dependent patients with watermelon stomach. Lasers Med Sci 2004; 18: 213-218
    CrossrefPubMedSearch in Google Scholar
  • 44 Kantsevoy SV, Cruz-Correa MR, Vaughn CA et al. Endoscopic cryotherapy for the treatment of bleeding mucosal vascular lesions of the GI tract: a pilot study. Gastrointest Endosc 2003; 57: 403-406
    CrossrefPubMedSearch in Google Scholar
  • 45 Cho S, Zanati S, Yong E et al. Endoscopic cryotherapy for the management of gastric antral vascular ectasia. Gastrointest Endosc 2008; 68: 895-902
    CrossrefPubMedSearch in Google Scholar
  • 46 Petrini Jr JL, Johnston JH. Heat probe treatment for antral vascular ectasia. Gastrointest Endosc 1989; 35: 324-328
    CrossrefPubMedSearch in Google Scholar
  • 47 Komiyama M, Fu K, Morimoto T et al. A novel endoscopic ablation of gastric antral vascular ectasia. World J Gastrointest Endosc 2010; 2: 298-300
    CrossrefPubMedSearch in Google Scholar
  • 48 Chong VH. Snare coagulation for gastric antral vascular ectasia ablation. Gastrointest Endosc 2009; 69: 1195
    PubMedSearch in Google Scholar
  • 49 Okamoto T, Okayama Y, Hirai M et al. Gastric vascular ectasia treated by endoscopic mucosal resection. Dig Endosc 2002; 14: 9-11
    CrossrefPubMedSearch in Google Scholar
  • 50 Sherman V, Klassen DR, Feldman LS et al. Laparoscopic antrectomy: a novel approach to treating watermelon stomach. J Am Coll Surg 2003; 197: 864-867
    CrossrefPubMedSearch in Google Scholar
  • 51 Spahr L, Villeneuve JP, Dufresne MP et al. Gastric antral vascular ectasia in cirrhotic patients: absence of relation with portal hypertension. Gut 1999; 44: 739-742
    CrossrefPubMedSearch in Google Scholar
  • 52 Fuccio L, Mussetto A, Laterza L et al. Diagnosis and management of gastric antral vascular ectasia. World J Gastrointest Endosc 2013; 51: 6-13
    PubMedSearch in Google Scholar
  • 53 Schulz SW, O’Brien M, Maqsood M et al. Improvement of severe systemic sclerosis-associated gastric antral vascular ectasia following immunosuppressive treatment with intravenous cyclophosphamide. J Rheumatol 2009; 36: 1653-1656
    CrossrefPubMedSearch in Google Scholar
  • 54 Soykan I, Toruner M, Idilman R et al. Reversal of iron deficiency anemia in a patient with gastric antral vascular ectasia treated with cyproheptadine. J Clin Gastroenterol 2003; 36: 183-184
    CrossrefPubMedSearch in Google Scholar
  • 55 Ge ZZ, Chen HM, Gao YJ et al. Efficacy of thalidomide for refractory gastrointestinal bleeding from vascular malformation. Gastroenterology 2011; 141: 1629-1637 e1–e4
    CrossrefPubMedSearch in Google Scholar
  • 56 Nardone G, Rocco A, Balzano T et al. The efficacy of octreotide therapy in chronic bleeding due to vascular abnormalities of the gastrointestinal tract. Aliment Pharmacol Ther 1999; 13: 1429-1436
    CrossrefPubMedSearch in Google Scholar
  • 58 Barbara G, De Giorgio R, Salvioli B et al. Unsuccessful octreotide treatment of the watermelon stomach. J Clin Gastroenterol 1998; 26: 345-346
    CrossrefPubMedSearch in Google Scholar
  • 57 Calam J, Walker RJ. Antral vascular lesion, achlorhydria, and chronic gastrointestinal blood loss: response to steroids. Dig Dis Sci 1980; 25: 236-239
    CrossrefPubMedSearch in Google Scholar
  • 59 Tran A, Villeneuve JP, Bilodeau M et al. Treatment of chronic bleeding from gastric antral vascular ectasia (GAVE) with estrogen-progesterone in cirrhotic patients: an open pilot study. Am J Gastroenterol 1999; 94: 2909-2911
    CrossrefPubMedSearch in Google Scholar
  • 60 Moss SF, Ghosh P, Thomas DM et al. Gastric antral vascular ectasia: maintenance treatment with oestrogen-progesterone. Gut 1992; 33: 715-717
    CrossrefPubMedSearch in Google Scholar