Angiodysplasia: characterization, diagnosis, and advances in treatment.
Gastrointestinal bleeding accounts for 2% of all adult hospital admissions each year. Angiodysplasia is one of the most frequently reported causes of lower gastrointestinal bleeding. In 80% of patients with bleeding angiodysplasia, the bleeding will stop spontaneously, but will often recur. Although angiography may detect bleeding in 86% of actively bleeding patients, the bleeding rate must be at least 0.5 mL/min. The treatment of choice for control of bleeding has been resection of the suspected segment of bowel, but this procedure is associated with a 10% rebleeding rate and 7% to 8% mortality. Superselective catheterization with infusion of vasoconstrictors has been used to control bleeding, but effects are short-lived. Superselective embolization occludes an offending vessel, but is difficult to perform accurately and is associated with risk of infarction. Laser photocoagulation controls bleeding in 84% of patients, with a 6% complication rate. This method of controlling bleeding offers distinct advantages, especially for the hemodynamically unstable patient. Except for cases in which surgical resection is indicated, Nd:YAG laser photocoagulation is the safest, least invasive, and probably most effective means of treating angiodysplasia.
Helmrich
G A
GA
Department of Pediatrics, University of South Carolina School of Medicine, Columbia.
Stallworth
J R
JR
Brown
J J
JJ
D000368:Aged; D003113:Colonoscopy; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005069:Evaluation Studies as Topic; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D008028:Light Coagulation; D012008:Recurrence; D014652:Vascular Diseases / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery