THE WATERMELON STOMACH - LONG-TERM OUTCOME IN PATIENTS TREATED WITH ND-YAG LASER THERAPY

Watermelon stomach is an unusual cause of gastrointestinal bleeding an d iron deficiency anemia. Its etiology is unknown, but it has been rep orted to be associated with a variety of diseases, including autoimmun e disorders and cirrhosis. We report on the long-term outcome of 15 pa tients (13 women, 2 men) treated with neodymium-yttrium-aluminum-garne t (Nd:YAG) laser therapy. The mean age of patients at presentation was 71.6 years (range, 59 to 85 years). Fourteen patients were transfusio n-dependent, requiring an average of 9.6 units of blood in the 12 mont hs preceding diagnosis and treatment. Associated diseases included scl eroderma (3 patients), mixed connective tissue disease (1 patient), hi story of cancer (3 patients), cryptogenic cirrhosis (3 patients), and chronic renal failure (3 patients). In 7 of 9 patients who had an anti nuclear antibody test, an elevated titer greater than 1:160 in a speck led pattern was noted. Nd:YAG laser coagulation therapy was administer ed to all patients without complications and was successful in reducin g bleeding in every case. Five patients died during the course of foll ow-up without signs of recurrent gastrointestinal bleeding. The remain ing 10 patients have had both endoscopic and hematologic improvement d uring a mean follow-up period of 4.4 years from the time of initial di agnosis (range, 2 to 8 years). The 10 survivors are no longer transfus ion-dependent and have stable hematocrits.