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Watermelon stomach: pathophysiology, diagnosis, and management
Yuri W Novitsky1, Kent W Kercher, Donald R Czerniach
1Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA. novitsky@ummhc.org
Summary
Watermelon Stomach (WS) causes significant gastrointestinal bleeding and anemia. Early surgical intervention may be more effective than endoscopic therapy for patients with this condition.
Area of Science:
- Gastroenterology
- Gastrointestinal Endoscopy
- Surgical Gastroenterology
Background:
- Watermelon Stomach (WS) is an increasingly recognized cause of occult gastrointestinal bleeding.
- Patients often present with severe iron deficiency anemia and transfusion dependency.
- Histologic hallmarks include fibromuscular hyperplasia and capillary ectasia in the gastric antrum.
Purpose of the Study:
- To review the pathophysiology, diagnosis, and treatment of Watermelon Stomach.
- To evaluate the efficacy of different treatment modalities, including endoscopic and surgical options.
- To propose an optimized treatment strategy for WS.
Main Methods:
- Review of literature on Watermelon Stomach.
- Analysis of endoscopic and histologic findings.
- Evaluation of treatment outcomes for endoscopic and surgical interventions.
Main Results:
- Endoscopic findings of "watermelon stripes" are pathognomonic for WS.
- Endoscopic therapies (thermal ablations) are the primary conservative treatment.
- Many patients fail endoscopic therapy, experiencing recurrent bleeding.
- Surgical resection offers a potential cure and eliminates transfusion dependency.
Conclusions:
- Watermelon Stomach necessitates effective management strategies due to potential for severe bleeding.
- Endoscopic therapy is the initial treatment, but recurrence is common.
- A more aggressive surgical approach is recommended for patients who fail initial endoluminal therapy to achieve definitive cure.