Angiodysplasia medical therapy: Difference between revisions
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*'''Argon plasma coagulation (APC):''' Most widely used endoscopic method for the treatment of angiodysplasia that uses high frequency electric current and ionised [[argon]] gas.<ref name="pmid14722558">{{cite journal| author=Vargo JJ| title=Clinical applications of the argon plasma coagulator. | journal=Gastrointest Endosc | year= 2004 | volume= 59 | issue= 1 | pages= 81-8 | pmid=14722558 | doi=10.1016/s0016-5107(03)02296-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14722558 }} </ref> It is a safe and effective method of treating gastrointestinal vascular lesions.<ref name="pmid16923494">{{cite journal| author=Suzuki N, Arebi N, Saunders BP| title=A novel method of treating colonic angiodysplasia. | journal=Gastrointest Endosc | year= 2006 | volume= 64 | issue= 3 | pages= 424-7 | pmid=16923494 | doi=10.1016/j.gie.2006.04.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16923494 }} </ref> | *'''Argon plasma coagulation (APC):''' Most widely used endoscopic method for the treatment of angiodysplasia that uses high frequency electric current and ionised [[argon]] gas.<ref name="pmid14722558">{{cite journal| author=Vargo JJ| title=Clinical applications of the argon plasma coagulator. | journal=Gastrointest Endosc | year= 2004 | volume= 59 | issue= 1 | pages= 81-8 | pmid=14722558 | doi=10.1016/s0016-5107(03)02296-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14722558 }} </ref> It is a safe and effective method of treating gastrointestinal vascular lesions.<ref name="pmid16923494">{{cite journal| author=Suzuki N, Arebi N, Saunders BP| title=A novel method of treating colonic angiodysplasia. | journal=Gastrointest Endosc | year= 2006 | volume= 64 | issue= 3 | pages= 424-7 | pmid=16923494 | doi=10.1016/j.gie.2006.04.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16923494 }} </ref> | ||
*'''[[Electrocoagulation]]:''' This technique of using thermal energy to coagulate the lesions is no longer recommended due to risk of severe complications including bowel perforation.<ref name="pmid19410037">{{cite journal| author=Asge Technology Committee. Conway JD, Adler DG, Diehl DL, Farraye FA, Kantsevoy SV | display-authors=etal| title=Endoscopic hemostatic devices. | journal=Gastrointest Endosc | year= 2009 | volume= 69 | issue= 6 | pages= 987-96 | pmid=19410037 | doi=10.1016/j.gie.2008.12.251 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19410037 }} </ref> | *'''[[Electrocoagulation]]:''' This technique of using thermal energy to coagulate the lesions is no longer recommended due to risk of severe complications including bowel perforation.<ref name="pmid19410037">{{cite journal| author=Asge Technology Committee. Conway JD, Adler DG, Diehl DL, Farraye FA, Kantsevoy SV | display-authors=etal| title=Endoscopic hemostatic devices. | journal=Gastrointest Endosc | year= 2009 | volume= 69 | issue= 6 | pages= 987-96 | pmid=19410037 | doi=10.1016/j.gie.2008.12.251 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19410037 }} </ref> | ||
*'''Photocoagulation:''' Uses Nd:YAG (neodymium:yttrium-aluminium-garnet) and Argon laser for photoablation of the lesions. This technique is mainly used for gastric antral vascular ectasia. Disadvantages include risk of perforation, uneconomical and requirement of specialist expertise. | *'''Photocoagulation:''' Uses Nd:YAG (neodymium:yttrium-aluminium-garnet) and Argon laser for photoablation of the lesions. This technique is mainly used for gastric antral vascular ectasia. Disadvantages include risk of perforation, uneconomical and requirement of specialist expertise.<ref name="pmid16284614">{{cite journal| author=Selinger RR, McDonald GB, Hockenbery DM, Steinbach G, Kimmey MB| title=Efficacy of neodymium:YAG laser therapy for gastric antral vascular ectasia (GAVE) following hematopoietic cell transplant. | journal=Bone Marrow Transplant | year= 2006 | volume= 37 | issue= 2 | pages= 191-7 | pmid=16284614 | doi=10.1038/sj.bmt.1705212 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16284614 }} </ref><ref name="pmid3262793">{{cite journal| author=Gostout CJ, Bowyer BA, Ahlquist DA, Viggiano TR, Balm RK| title=Mucosal vascular malformations of the gastrointestinal tract: clinical observations and results of endoscopic neodymium: yttrium-aluminum-garnet laser therapy. | journal=Mayo Clin Proc | year= 1988 | volume= 63 | issue= 10 | pages= 993-1003 | pmid=3262793 | doi=10.1016/s0025-6196(12)64914-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3262793 }} </ref> | ||
==References== | ==References== | ||
Revision as of 05:54, 15 October 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nikita Singh, M.D.[2]
Overview
Treatment is not required for incidentally found, asymptomatic, non-bleeding lesions. However, it is considered for non-bleeding angiodysplasia with symptoms of occult or overt GI bleed. The invasiveness of therapy depends on clinical severity of anemia, hemodynamic stability and recurrence of symptoms. Although endoscopic techniques are the first choice, hormonal therapy, thalidomide and octreotide are the pharmacological options that have been tried for patients with significant co-morbidities who cannot undergo invasive procedures.
Medical Therapy
- Pharmacological options like hormonal therapy, thalidomide, and octreotide have been tried in patients with significant co-morbidities who cannot undergo invasive procedures.
- Studies have shown hormonal therapy with ethinylestradiol and norethisterone vs placebo have no difference in outcomes.[1] However, a few case series have shown positive results regarding the efficacy of hormonal therapy in chronic renal failure patients.[2]
- Thalidomide inhibits angiogenesis by inhibiting vascular endothelial growth factor (VEGF)- and basic fibroblast growth factor (bFGF)-induced angiogenesis.[3] It has been reported to be effective in the management of chronic bleeding from angiodysplasia as well as reduction in the number and size of lesions in numerous.[4][5][6][7]
- Long-acting octreotide has been used to treat chronic bleeding due to angiodysplasia in elderly patients.[8]
Endoscopic Therapy
- Endoscopic techniques are the therapy of choice for angiodysplasia.
- Argon plasma coagulation (APC): Most widely used endoscopic method for the treatment of angiodysplasia that uses high frequency electric current and ionised argon gas.[9] It is a safe and effective method of treating gastrointestinal vascular lesions.[10]
- Electrocoagulation: This technique of using thermal energy to coagulate the lesions is no longer recommended due to risk of severe complications including bowel perforation.[11]
- Photocoagulation: Uses Nd:YAG (neodymium:yttrium-aluminium-garnet) and Argon laser for photoablation of the lesions. This technique is mainly used for gastric antral vascular ectasia. Disadvantages include risk of perforation, uneconomical and requirement of specialist expertise.[12][13]
References
- ↑ Junquera F, Feu F, Papo M, Videla S, Armengol JR, Bordas JM; et al. (2001). "A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia". Gastroenterology. 121 (5): 1073–9. doi:10.1053/gast.2001.28650. PMID 11677198.
- ↑ Bronner MH, Pate MB, Cunningham JT, Marsh WH (1986). "Estrogen-progesterone therapy for bleeding gastrointestinal telangiectasias in chronic renal failure. An uncontrolled trial". Ann Intern Med. 105 (3): 371–4. doi:10.7326/0003-4819-105-3-371. PMID 3488703.
- ↑ Chen HM, Ge ZZ, Liu WZ, Lu H, Xu CH, Fang JY; et al. (2009). "[The mechanisms of thalidomide in treatment of angiodysplasia due to hypoxia]". Zhonghua Nei Ke Za Zhi. 48 (4): 295–8. PMID 19576118.
- ↑ Heidt J, Langers AM, van der Meer FJ, Brouwer RE (2006). "Thalidomide as treatment for digestive tract angiodysplasias". Neth J Med. 64 (11): 425–8. PMID 17179574.
- ↑ Almadi M, Ghali PM, Constantin A, Galipeau J, Szilagyi A (2009). "Recurrent obscure gastrointestinal bleeding: dilemmas and success with pharmacological therapies. Case series and review". Can J Gastroenterol. 23 (9): 625–31. doi:10.1155/2009/862816. PMC 2776553. PMID 19816627.
- ↑ Kamalaporn P, Saravanan R, Cirocco M, May G, Kortan P, Kandel G; et al. (2009). "Thalidomide for the treatment of chronic gastrointestinal bleeding from angiodysplasias: a case series". Eur J Gastroenterol Hepatol. 21 (12): 1347–50. doi:10.1097/MEG.0b013e32832c9346. PMID 19730385.
- ↑ Bauditz J, Lochs H, Voderholzer W (2006). "Macroscopic appearance of intestinal angiodysplasias under antiangiogenic treatment with thalidomide". Endoscopy. 38 (10): 1036–9. doi:10.1055/s-2006-944829. PMID 17058171.
- ↑ Orsi P, Guatti-Zuliani C, Okolicsanyi L (2001). "Long-acting octreotide is effective in controlling rebleeding angiodysplasia of the gastrointestinal tract". Dig Liver Dis. 33 (4): 330–4. doi:10.1016/s1590-8658(01)80087-6. PMID 11432511.
- ↑ Vargo JJ (2004). "Clinical applications of the argon plasma coagulator". Gastrointest Endosc. 59 (1): 81–8. doi:10.1016/s0016-5107(03)02296-x. PMID 14722558.
- ↑ Suzuki N, Arebi N, Saunders BP (2006). "A novel method of treating colonic angiodysplasia". Gastrointest Endosc. 64 (3): 424–7. doi:10.1016/j.gie.2006.04.032. PMID 16923494.
- ↑ Asge Technology Committee. Conway JD, Adler DG, Diehl DL, Farraye FA, Kantsevoy SV; et al. (2009). "Endoscopic hemostatic devices". Gastrointest Endosc. 69 (6): 987–96. doi:10.1016/j.gie.2008.12.251. PMID 19410037.
- ↑ Selinger RR, McDonald GB, Hockenbery DM, Steinbach G, Kimmey MB (2006). "Efficacy of neodymium:YAG laser therapy for gastric antral vascular ectasia (GAVE) following hematopoietic cell transplant". Bone Marrow Transplant. 37 (2): 191–7. doi:10.1038/sj.bmt.1705212. PMID 16284614.
- ↑ Gostout CJ, Bowyer BA, Ahlquist DA, Viggiano TR, Balm RK (1988). "Mucosal vascular malformations of the gastrointestinal tract: clinical observations and results of endoscopic neodymium: yttrium-aluminum-garnet laser therapy". Mayo Clin Proc. 63 (10): 993–1003. doi:10.1016/s0025-6196(12)64914-3. PMID 3262793.