Watermelon stomach (WMS) is an unusual but significant source of recurrent upper gastrointestinal hemorrhage (UGIH)and anemia. The diagnosis is based on the characteristic endoscopic appearance of antral angiomas (AVM's) radiating in arrays to the pylorus. Some WMS patients also have portal hypertension (PH). Different endoscopic treatments (Rx) have been successfully used to treat WMS but outcomes in the PH sub-group have not been reported. In WMS patients, with and without PH, our purposes were to describe patient demographics, endoscopic appearances, and outcomes after endoscopic Rx. Methods: 26/744 (4%) of consecutive patients with non-variceal UGIH enrolled in our prospective hemostasis studies from 1991-9 had WMS. 8/26 (31%) with WMS also had PH and esophageal varices. Rx was with gold probe (n=13), heater probe (n=7), or argon plasma coagulator (n=6). Research nurses completed standardized data collection forms using medical records and telephone calls to blood banks, clinics, and hospitals. SAS was used for data management/analysis. Comparisons were made using Wilcoxon rank sum and signed rank tests. Results: Median age was 74 years for PH and 75 for WMS patients. 5/8 (63%) of PH and 16/18 (89%) of WMS cases were female. 75% of PH and 50% of WMS cases presented with melena, but none had hypotension. 88% of PH, but only 39% of WMS patients had active bleeding at endoscopy. PH patients also had more diffuse and smaller AVM's than other WMS patients. Median follow-up was 301 days for PH and 1005 days for WMS (p<.05). See TABLE for treatment outcomes by group. Median number of bleeding-related hospitalizations Pre- vs Post-Rx was 1 vs. 0 for PH, and 4 vs. 0 for WMS(p<.05). Conclusions: 1) WMS patients with and without PH were similar in age, gender, and clinical presentation. 2) Endoscopic findings differed in that PH patients had more diffuse antral lesions and varices. 3) Bleeding from Watermelon Stomach was effectively palliated by endoscopic treatment, with reduced PRBC transfusions and bleedingrelated hospitalizations, regardless of the presence of portal hypertension