GAVE — Gastric Antral Vascular Ectasia

Gastric antral vascular ectasia (GAVE), classically called watermelon stomach, is a vascular disorder of the gastric antrum characterized by ectatic mucosal capillaries and submucosal venules. It typically presents as chronic occult blood loss with iron-deficiency anemia, sometimes requiring repeated transfusions. Overt hematemesis or melena is uncommon.

The endoscopic appearance is the diagnostic anchor: longitudinal, parallel red stripes converging on the pylorus along the rugal folds (the "watermelon" pattern), or a diffuse punctate / nodular variant that can be mistaken for portal hypertensive gastropathy. GAVE is most commonly seen in older women, in patients with cirrhosis, autoimmune disease (especially scleroderma), chronic kidney disease, and post bone-marrow transplant.

Endoscopic ablation is first-line. Argon plasma coagulation (APC) is widely used and effective, but typically requires repeat sessions. Endoscopic band ligation has emerged as an alternative — particularly for nodular GAVE — with comparable hemoglobin response and fewer sessions in several comparative studies. Radiofrequency ablation and cryotherapy are options at experienced centers. Refractory cases may require antrectomy.