Gastric antral vascular ectasia (watermelon stomach) in patients with ESRD

Abstract

In 1989, Navab et al suggested that watermelon stomach often is observed in patients with chronic renal insufficiency. On the basis of this and some later reports, an etiopathogenetic association between the 2 disorders was postulated. However, the number of relevant publications is still very limited. We describe 2 patients with end-stage renal disease (ESRD; 1 patient, hemodialysis therapy; 1 patient, peritoneal dialysis therapy) and watermelon stomach who presented with upper gastrointestinal bleeding and severe transfusion-dependent iron-deficiency anemia. In 1 patient, apart from the characteristic endoscopic findings of watermelon stomach affecting the antrum, there were vascular ectatic lesions in the proximal stomach. Both patients were treated successfully by using endoscopic bipolar electrocoagulation (Gold probe [GP]; Microvasive Boston Scientific, Natick, MA), which led to significant endoscopic and hematologic improvement. However, upper-gastrointestinal bleeding recurred in the second patient (peritoneal dialysis) because she did not consent to undergo endoscopic treatment on a regular basis. Watermelon stomach in patients with ESRD is a serious condition that can cause either acute or chronic upper-gastrointestinal bleeding. It should be considered in patients with upper-gastrointestinal bleeding and those with iron-deficiency anemia, which frequently presents as recombinant human erythropoietin resistance in patients with ESRD. Diagnosis is based on the distinctive endoscopic appearance of the antrum, but the proximal stomach also may be involved. Application of GP ablation seems to be a safe and effective treatment for watermelon stomach.