Gastric Antral Vascular Ectasias - GAVE (1 of 6)

This 54 year-old alcoholic male had melena and stigmata of bleeding in an previous endoscopy one week before to this one, presented with ascitis and esophageal varices that were ligated in three different sessions. Portal hypertensive gastropathy and gastric antral vascular ectasias (GAVE) are both potential causes of upper GI bleeding. While they can be seen in patients with cirrhosis, it is quite uncommon to find them in the same patient. In portal hypertensive gastropathy, the mucosa is friable and bleeding occurs when the ectatic vessels rupture and manifest as mucosal oozing. The characteristic endoscopic appearance of fine white reticular pattern separating the areas of pinkish mucosa has been described as "snake skin". The pathogenesis of this disorder involves congestion and hyperemia of the mucosa. GAVE or watermelon stomach characterized by rows of flat reddish stripes radiating from the pylorus, which can sometimes be confused with portal hypertensive gastropathy. While it can be seen in patients with cirrhosis, most cases are idiopathic. Portal decompression with TIPS does not reduce bleeding caused by GAVE. Antrectomy is reserved as a last option for patients who fail endoscopic therapies. Endoscopic coagulation with heater probe, gold probe or argon plasma coagulator (APC) obliterates the vascular ectasias and reduces the degree of blood loss. More than one session may be needed.