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Introduction Watermelon stomach or formally Gastric Antral Vascular Ectasia (GAVE) is a recognized manifestation of systemic sclerosis (SSc), causing persistent gastrointestinal bleeding from dilated antral vessels, resembling stripes of watermelon and leading to chronic anemia. Reported prevalence rates vary widely across studies, ranging from 1% to 76%. This study aims to determine the frequency and clinical characteristics of GAVE in patients with SSc in central Greece.Material and Methods Data from all patients with SSc followed by the Department of Rheumatology and Clinical Immunology, Larissa, Greece were retrospectively reviewed. Only patients diagnosed with GAVE were included in the final analysis. Demographics, clinical features, time of GAVE onset, autoantibodies profile and therapeutic endoscopic interventions were documented.Results Our database includes 115 SSc individuals who underwent gastroscopy (male/female ratio: 18/97, mean age at endoscopy: 62.9 ± 14.1 years), of whom 11 (9.6%) were diagnosed with GAVE. The mean age at GAVE onset was 64.5 ± 15.57 years with a strong female predominance (91%). Watermelon stomach preceded the diagnosis of SSc in 3 cases and was apparent at diagnosis in other 4 cases. Most patients (8 out of 11) had limited SSc. Skin telangiectasias were noted in 45%. Digital ulcers were documented in 4 patients and calcinosis in 2 patients. Arthritis was also recorded in 2 patients. None had a history of renal crisis. GAVE seemed to be associated with the presence of anti-centromere antibodies (ACA) since 8 out of 11 patients (73%) were found positive. The presenting symptom in above half of the patients (55%) was anemia. 4 individuals with more severe anemia (Hemoglobulin, Hb < 7.5 mg/dl) were treated successfully with argon plasma coagulation (APC).Conclusions GAVE is a well-established gastrointestinal complication associated with SSc. However, its true prevalence remains unclear as reported rates differ considerably across studies, indicating a substantial gap in the literature. To our knowledge, this is the first study to investigate the frequency and clinical characteristics of GAVE in the Greek SSc population. GAVE appears to be more frequently associated with the limited subtype and in some cases may even be the initial manifestation, presenting as prolonged anemia. Although relatively rare, clinicians should maintain a high index of suspicion in SSc patients with unexplained anemia or signs of gastrointestinal bleeding. Likewise, gastroenterologists who identify vascular ectasias during endoscopy, particularly in undiagnosed patients, should consider evaluating for systemic features such as Raynaud’s phenomenon, which may suggest underlying SSc.Abstract P.171 Figure 1