Angiodysplasia
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Angiodysplasia | |
An angiodysplasia in the colon being treated with argon plasma coagulation administered via probe through the colonoscope. The patient had multiple colonic angiodysplasiae in the setting of aortic stenosis. | |
ICD-10 | K55.2 |
ICD-9 | 569.84, 569.85 |
DiseasesDB | 2963 |
MeSH | D016888 |
Angiodysplasia Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Angiodysplasia On the Web |
American Roentgen Ray Society Images of Angiodysplasia |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Colonic angiodysplasia; colonic arteriovenous malformation; vascular ectasia of the colon; angioectasia
Diagnosis
Diagnosis of angiodysplasia is often accomplished with endoscopy, either colonoscopy or esophagogastroduodenoscopy (EGD). Although the lesions can be notoriously hard to find, the patient usually is diagnosed by endoscopy. A new technique, pill enteroscopy, has been a major advance in diagnosis, especially in the small bowel which is difficult to reach with traditional endoscopy. With this technique a pill that contains a video camera and radio transmitter is swallowed, and pictures of the small intestine are sent to a receiver worn by the patient.
Angiodysplasiae in the small bowel can also be diagnosed and treated with double-balloon enteroscopy, a technique involving a long endoscopic camera and overtube, both fitted with balloons, that allow the bowel to be accordioned over the camera.[1]
In cases with negative endoscopic findings and high clinical suspicion, selective angiography of the mesenteric arteries is sometimes necessary, but this allows for interventions at time of the procedure. An alternative is scintigraphy with red blood cells labeled with a radioactive marker; this shows the site of the bleeding on a gamma camera but tends to be unhelpful unless the bleeding is continuous and significant.[2]
Therapy
If the anemia is severe, blood transfusion is required before any other intervention is considered. Endoscopic treatment is an initial possibility, where cautery or argon plasma coagulation (APC) laser treatment is applied through the endoscope. Resection of the affected part of the bowel may be needed. However, the lesions may be widespread, making such treatment impractical. Embolisation through angiography is occasionally contemplated with severely bleeding lesions that cannot be visualised on colonoscopy.
If the bleeding is from multiple or inaccessible sites, systemic therapy with medication may be necessary. First-line options include the antifibrinolytics tranexamic acid or aminocaproic acid. Estrogens can be used to stop bleeding from angiodysplasia. Estrogens cause mild hypercoaguability of the blood. Estrogen side effects can be dangerous and unpleasant in both sexes. Changes in voice and breast swelling is bothersome in men, but older women often report improvement of libido and perimenopausal symptoms. (The worries about hormone replacement therapy/HRT, however, apply here as well.)
In difficult cases, there have been positive reports about octreotide[3] and thalidomide,[4]
In severe cases or cases not responsive to either endoscopic or medical treatment, surgery may be necessary to arrest the bleeding.
References
- ↑ Neumann H, Mönkemüller K, Malfertheiner P (2007). "Obscure overt GI bleeding secondary to angiodysplasias at the hepaticojejunostomy diagnosed and successfully treated with double-balloon enteroscopy". Gastrointest Endosc: 563. doi:10.1016/j.gie.2007.06.051. PMID 17981272.
- ↑ Mitchell SH, Schaefer DC, Dubagunta S (2004). "A new view of occult and obscure gastrointestinal bleeding". Am Fam Physician. 69 (4): 875–81. PMID 14989574.
- ↑ Junquera F, Saperas E, Videla S, Feu F, Vilaseca J, Armengol JR, Bordas JM, Piqué JM, Malagelada JR (2007). "Long-term efficacy of octreotide in the prevention of recurrent bleeding from gastrointestinal angiodysplasia". Am. J. Gastroenterol. 102 (2): 254–60. doi:10.1111/j.1572-0241.2007.01053.x. PMID 17311647.
- ↑ Shurafa M, Kamboj G (2003). "Thalidomide for the treatment of bleeding angiodysplasias". Am. J. Gastroenterol. 98 (1): 221–2. doi:10.1111/j.1572-0241.2003.07201.x. PMID 12526972.