Endoscopy 2002; 34(5): 407-410
DOI: 10.1055/s-2002-25287
Original Article

© Georg Thieme Verlag Stuttgart · New York

Argon Plasma Coagulation for Treatment of Watermelon Stomach

I.  Yusoff1 , F.  Brennan1 , D.  Ormonde1 , B.  Laurence1
  • 1Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia
Further Information

Publication History

9 May 2001

3 November 2001

Publication Date:
22 April 2002 (online)

Background and Study Aims: Watermelon stomach or gastric antral vascular ectasia (GAVE) is a rare but well-recognized cause of gastrointestinal blood loss, which typically affects elderly women. Historically patients were treated with antrectomy but this has been largely replaced by endoscopic therapy such as Nd:YAG laser. Argon plasma coagulation (APC) is a new noncontact electocoagulation technique which has several theoretical advantages over laser. The objective of this study was to assess the efficacy of APC in treating GAVE.
Patients and Methods: We retrospectively reviewed the case-records of five patients (four women, one man) with iron deficiency anaemia or gastrointestinal blood loss due to GAVE who were treated with APC and for whom a follow-up of more than 12 months was available. Four patients were transfusion-dependent. Their mean age was 71 years (range 58 - 83). The mode of presentation, number of treatment sessions, response to therapy and recurrence (if any) were recorded.
Results: A mean of 2.6 treatment sessions per patient were required. All patients had an endoscopically observed response to therapy and all patients had a sustained rise in hemoglobin level after treatment. Transfusion dependence ceased in all patients. After a mean follow-up of 20 months GAVE recurred in two patients (40 %). Both patients responded to further APC treatment. No major complications were recorded.
Conclusion: APC is a safe and effective short-term treatment for GAVE. The natural history of the condition is uncertain, and at medium-term follow-up GAVE is found to recur in a substantial number of patients treated with APC. Re-treatment with APC is an option in these patients.

References

  • 1 Jabbari M, Cherry R, Lough J O. et al . Gastric antral vascular ectasia: The watermelon stomach.  Gastroenterology. 1984;  87 1165-1170
  • 2 Park R HR, Russell R I. Watermelon stomach.  Br J Surg. 1991;  78 395-396
  • 3 Gretz J E, Achem S R. The watermelon stomach: clinical presentation, diagnosis, and treatment.  Am J Gastroenterol. 1999;  94 2909-2911
  • 4 Szold A, Katz L B, Lewis B S. Surgical approach to gastrointestinal bleeding.  Am J Surg. 1992;  163 90-93
  • 5 Gostout C J, Viggiano T R, Ahlquist D A. et al . The clinical and endoscopic spectrum of the watermelon stomach.  J Clin Gastroenterol. 1992;  15 256-263
  • 6 Bourke M J, Hope R L, Boyd P. et al . Endoscopic laser for watermelon stomach.  J Gastroenterol Hepatol. 1996;  11 832-834
  • 7 Gostout C J, Ahlquist D A, Radford C M. et al . Endoscopic laser therapy for watermelon stomach.  Gastroenterology. 1989;  96 1462-1465
  • 8 Tsai H H, Smith J, Danesh B J. Successful control of bleeding from gastric antral vascular ectasia (watermelon stomach) by laser photocoagulation.  Gut. 1991;  32 93-94
  • 9 Kamberoglou D, Kakkak M, Bennett J R. Case of watermelon stomach successfully treated by heater probe coagulation.  Gut. 1992;  33 964
  • 10 Liberski S M, Mcgarrity T J, Hartle R J. et al . The watermelon stomach: long-term outcome in patients treated with Nd:YAG laser therapy.  Gastrointest Endosc. 1994;  40 584-587
  • 11 Tran A, Villleneuve J P, 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
  • 12 Moss S H, Ghosh P, Thomas D M. et al . Gastric antral vascular ectasia: maintenance therapy with oestrogen-progesterone.  Gut. 1992;  33 715-717
  • 13 Brennan F N, Cowen A E, Laurence B H. Successful treatment of two patients with gastric antral vascular ectasia “watermelon stomach” using endoscopic Nd-Yag laser therapy.  Aust NZ J Med. 1991;  21 439-441
  • 14 Petrini J L Jr, Johnson J H. Heater probe treatment for antral vascular ectasia.  Gastrointest Endosc. 1989;  35 324-328
  • 15 Binmoeller K F, Katon R M. Bipolar coagulation for watermelon stomach.  Gastrointest Endosc. 1990;  36 399-402
  • 16 Potamiano S, Carter C R, Anerson J R. Endoscopic laser treatment of diffuse gastric antral vascular ectasia.  Gut. 1994;  53 461-463
  • 17 Klump B, Schneider G A, Fierlbeck G. et al . Argon plasma coagulation in endoscopic therapy of CREST syndrome associated upper gastrointestinal haemorrhage.  Z Gastroenterol. 1997;  35 469-476
  • 18 Focke G, Seidl C, Grouls V. Treatment of watermelon stomach (GAVE syndrome) with endoscopic argon plasma coagulation (APC). A new therapy approach.  Leber Magen Darm. 1996;  26 254, 257-259
  • 19 Wahab P J, Mulder C J, den Hartog G. et al . Argon plasma coagulation in flexible gastrointestinal endoscopy: pilot experiences.  Endoscopy. 1997;  29 176-181
  • 20 Grund K E, Straub T, Farin G. New haemostatic techniques: argon plasma coagulation.  Baillieres Best Pract Res Clin Gastroenterol. 1999;  13 67-84
  • 21 Cohen J, Abedi M, Haber G. et al . Argon plasma coagulation: a new effective technique of non-contact thermal coagulation. Experience in 44 cases of GI angiomata.  Gastrointest Endosc. 1996;  43 293
  • 22 Suit P F, Petras R E, Bauer T W. et al . Gastric antral vascular ectasia: A histologic and morphometric study of the “watermelon stomach”.  Am J Surg Pathol. 1987;  11 750-757
  • 23 Gilliam J H , Geisinger K R, Wu W C. et al . Endoscopic biopsy is diagnostic in gastric antral vascular ectasia.  Dig Dis Sci. 1989;  34 885-888
  • 24 Spahr L, Villeneuve J-P, Dufresne M-P. et al . Gastric antral vascular extasia in cirrhotic patients: absence of relation with portal hypertension.  Gut. 1999;  44 739-742
  • 25 Johanns W, Luis W, Janssen J. et al . Argon plasma coagulation (APC) in gastroenterology: experimental and clinical experiences.  Eur J Gastroenterol Hepatol. 1997;  9 581-587
  • 26 Grund K E. Argon plasma coagulation (APC): ballyhoo or breakthrough?.  Endoscopy. 1997;  29 196-198
  • 27 Watson J P, Bennett M K, Griffin S M. et al . The tissue effect of argon plasma coagulation on esophageal and gastric mucosa.  Gastrointest Endosc. 2000;  52 342-345

Dr. Donald Ormonde

Department of Gastroenterology · Sir Charles Gairdner Hospital

Verdun St · Nedlands · Perth · Western Australia ·

Fax: + 61-8-9346-3207

Email: donormonde@iinet.net.au