Rapidly Progressive Coexistence of Gastric Antral Vascular Ectasia (GAVE) and Portal Hypertensive Gastropathy (PHG) Presenting With Iron Deficiency Anaemia: Successful Use of PuraStat in a Patient With Implantable Cardioverter-Defibrillator (ICD)

Gastric antral vascular ectasia (GAVE), or "watermelon stomach", is an uncommon but important cause of chronic gastrointestinal blood loss and iron deficiency anaemia (IDA). Although associated with cirrhosis and portal hypertension, it is regarded as distinct from portal hypertensive gastropathy (PHG), and the two conditions rarely coexist. We report an 85-year-old woman with cirrhosis and multiple comorbidities who presented with severe symptomatic IDA (Hb 60 g/L). Remarkably, oesophago-gastro-duodenoscopy (OGD) performed just five months earlier had been entirely normal, yet repeat gastroscopy revealed rapidly developed GAVE and PHG with active bleeding. Endoscopic images demonstrated both GAVE and coexistent PHG, an uncommon finding. Haemostasis was achieved with PuraStat, chosen instead of argon plasma coagulation (APC) due to the presence of an implantable cardioverter-defibrillator (ICD). The patient required a blood transfusion and intravenous iron therapy, was stabilised clinically, and was discharged with structured follow-up. This case highlights the rapid evolution of GAVE, its potential to cause severe anaemia, the unusual coexistence of GAVE and PHG, and the successful use of PuraStat as a novel haemostatic option when APC is contraindicated.