Radiofrequency ablation for gastric antral vascular ectasia

Gastric antral vascular ectasia (GAVE) syndrome, also known as 'watermelon stomach', is a rare but well‑recognised cause of chronic upper gastrointestinal blood loss. It is more common in older people. It may lead to iron‑deficiency anaemia and transfusion dependence. Rarely, it can cause acute haemorrhage. GAVE is associated with heterogeneous medical conditions, including hepatic, renal, cardiac and autoimmune diseases, but its pathogenesis is unknown. GAVE is characterised endoscopically by diffuse or linear red patches or spots in the antrum of the stomach, which can give a 'watermelon' type of appearance. The classic histopathological findings are vascular ectasia of mucosal capillaries, focal thrombosis, spindle cell proliferation and fibrohyalinosis.

Initial treatment for GAVE includes endoscopic thermoablation techniques (such as argon plasma coagulation, laser photoablation, cryotherapy) and band ligation. Some patients continue to need blood transfusions despite repeat endoscopic treatments. When endoscopic therapy is not successful, antrectomy may be considered. Surgical resection of the affected part of the stomach is curative, but is associated with risks of morbidity and mortality.