Combined Endoscopic Treatment of Gastric Arterio-Venous Malformation

Gastric antral vascular ectasia (GAVE), also known as “watermelon stomach,” is a rare but clinically significant cause of chronic anemia and upper gastrointestinal bleeding, particularly in elderly patients. Although uncommon, GAVE considerably affects quality of life due to recurrent bleeding, frequent hospitalizations, and the need for blood transfusions. Diagnosis is typically based on endoscopic findings, characterized by red, radiating streaks from the pylorus or multiple punctate angioectasias in the antrum. Therapeutic approaches include various endoscopic methods, most notably argon plasma coagulation (APC) and endoscopic band ligation (EBL), each with specific advantages and limitations. Recent studies have emphasized the benefits of combining these two modalities to achieve more effective and durable hemostasis.<br /> This case report presents a 79-year-old female patient with GAVE syndrome, manifested by chronic iron-deficiency anemia. Initially, the patient underwent APC, which provided temporary improvement but failed to achieve complete resolution. On follow-up endoscopy, persistent angioectatic lesions prompted a second-stage procedure using a combined treatment strategy: three elastic bands were applied to the most prominent vascular areas, followed by APC on residual superficial lesions. Over the next three months, the patient underwent regular endoscopic surveillance and laboratory monitoring. Follow-up assessments revealed significant clinical and endoscopic improvement, including normalization of hemoglobin levels and regression of vascular malformations, with no signs of recurrent anemia or bleeding.<br /> This clinical case highlights the effectiveness and safety of combined endoscopic therapy using EBL and APC in patients with refractory or recurrent GAVE. The synergistic action of both techniques allows for comprehensive treatment of both superficial and deeper vascular lesions, improving long-term outcomes and reducing the need for repeated interventions. Combined therapy may be considered the treatment of choice in complex GAVE cases, offering a promising strategy in routine endoscopic practice.