Gastric antral vascular ectasia successfully controlled by argon plasma coagulation.

Dear Editor, Gastric antral vascular ectasia (GAVE) is an uncommon but important cause of chronic gastrointestinal blood loss and iron deficiency anaemia. The syndrome was first described in 1953 by Ryder et al in the gastrectomy specimen of an elderly woman. It was not until 1984 when Jabbari et al described the unique endoscopic appearance as “prominent erythematous stripes radiating in a spokelike fashion from the pylorus to the antrum”. This led Jabbari et al to coin the term “watermelon stomach” for this condition. Biopsies usually show fibromuscular hyperplasia of lamina propria, intravenous fibrin thrombi and an increase in the mean cross-sectional area of the lumen in mucosal vessels. However, histology is not necessary for diagnosis of GAVE.1 We describe a patient with GAVE who was successfully treated with argon plasma coagulation (APC). A 51-year-old man was admitted in July 1995 for symptomatic anaemia. Physical examination was unremarkable and investigations showed iron deficiency anaemia. The haemoglobin level on admission was 5.7 g/dL. Serum iron and total iron binding capacity were 4 μmol/L and 75 μmol/L respectively. The patient was given blood transfusion and oesophagogastroduodenoscopy showed linear antral gastritis. He was subsequently discharged with oral ranitidine and ferrous fumarate. The haemoglobin level on discharge was 10.4 g/dL. The medications were continued and the patient’s haemoglobin level subsequently normalised. However, the stool occult blood was persistently positive. Oesophagogastroduodenoscopy in November 1996 showed linear antral gastritis and colonoscopy then was normal. The patient developed an episode of melaena in December 1997. Oesophagogastroduodenoscopy performed then revealed linear erythematous stripes and the diagnosis of GAVE was made. The melaena became more frequent in 2001 and the patient underwent 3 sessions of APC in that year. Oral omeprazole was commenced. Iron supplements were no longer required after the third APC. The fourth and fifth sessions of APC were performed in May 2002 and August 2003 respectively. The vascular ectasia had largely disappeared after the fifth APC. The patient remained well until August 2005 when melaena recurred. Oesophagogastroduodenoscopy then showed recurrence of GAVE (Fig. 1) and APC was performed. There were no further episodes of melaena thereafter. Gastric Antral Vascular Ectasia Successfully Controlled by Argon Plasma Coagulation