Beyond Watermelon Stomach: Risk Factors and Treatment of Recurrent Bleeding in Gastric Antral Vascular Ectasia (GAVE)

Gastric Antral Vascular Ectasia (GAVE) is a rare but clinically significant cause of chronic gastrointestinal bleeding and transfusion-dependent anemia, particularly in older women. Patients with comorbidities, such as cirrhosis, chronic kidney disease, or autoimmune disorders, are at risk of developing GAVE. Pharmacological therapies demonstrate limited efficacy in the management of GAVE. They are primarily utilized as a temporary measure, serving as a bridge to definitive therapy. Additionally, these agents may be considered for patients with contraindications to endoscopic or surgical interventions. Endoscopic therapy remains the first-line approach for GAVE. Among the available modalities, argon plasma coagulation (APC) and endoscopic band ligation (EBL) are most widely employed due to their proven effectiveness and safety profiles. However, both APC and EBL recurrence rates remain high, especially in diffuse or severe cases. Radiofrequency ablation (RFA) has emerged as a promising alternative, particularly for recurrent cases; however, long-term outcomes require further validation. Surgical interventions (eg, antrectomy) are reserved for refractory cases but carry higher risks.