Diagnosis and therapeutic strategies for small bowel vascular lesions

Shimizu, Eiji; Ohata, Ken; Nakajima, Atsushi; Matsuhashi, Nobuyuki

doi:10.3748/wjg.v25.i22.2720

Cited by 65 publications

(67 citation statements)

References 94 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In cases in which arteriovenous fistulas of AVM are very large, PVA or gelatin sponge particles should be avoided. The value of embolization is more notable for AVM and DL, but less for AE (1). The lesions of AVM and DL are usually more extensive than angioectasia.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of Transcatheter Arterial Embolization in Treating Gastrointestinal Bleeding Due to Angiodysplasia: A Retrospective Study on Twelve Cases

Zhao¹,

You²,

Wang³

et al. 2020

Iran J Radiol

View full text Add to dashboard Cite

Background: Angiodysplasia (AD) is a common cause of otherwise unexplained gastrointestinal bleeding and anemia and it increases in frequency with aging. Objectives: To investigate the safety and efficacy of transcatheter arterial embolization (TAE) in treating gastrointestinal bleeding caused by angiodysplasia. Patients and Methods: A total of 12 patients (five men, seven women; mean age: 50 ± 18 years; range: 31 - 82 years) with gastrointestinal bleeding, who had failed after endoscopic therapy and were not eligible for surgery, were treated via TAE. The presentations of patients included hematemesis (n = 2), melena (n = 7), and hematochezia (n = 5). The details of procedures and follow-up records were reviewed. Results: The procedures of TAE were performed using poly vinyl alcohol particles and/or coils. The procedures were achieved and the hemorrhage was controlled in all cases. In three patients, the small AD lesions were not found during the first session of angiography, but were instead detected on the repeated angiography conducted one week later. All the patients were discharged without any severe complications. No rebleeding occurred within 30 days following the embolization. Hemorrhage recurred in two patients within one year after hospital discharge. TAE procedures were performed once more using microcoils, and the bleeding was controlled. Conclusion: For the patients with refractory and repeated gastrointestinal hemorrhage due to angiodysplasia, TAE seems to be an effective alternative option when endoscopic examination and treatment do not work.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Angiodysplasia (AD), including arteriovenous malformation (AVM), Dieulafoy's lesion (DL) and angioectasia (AE), is an important cause of gastrointestinal (GI) hemorrhage, especially for small intestinal bleeding (1). AD prevails in the terminal ileum, cecum and right colon (2).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Transcatheter Arterial Embolization in Treating Gastrointestinal Bleeding Due to Angiodysplasia: A Retrospective Study on Twelve Cases

Zhao¹,

You²,

Wang³

et al. 2020

Iran J Radiol

View full text Add to dashboard Cite

show abstract

“…DBE helps in the diagnosis and treatment of small bowel pathological conditions, and in majority of the cases, it reduces the need for immediate surgical interventions. 10 A total of 112 DBE were performed over a period of 2 years, out of which 25 patients had undergone DBE without a CE for active small bowel bleeding. Eighteen (72%) of those patients in our study showed positive findings (DL, GIST, jejunal varices, angioectasia, ulcers) at DBE.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Double Balloon Enteroscopy for Managing Overt Small Bowel Bleeding

Dalal

Patil

Maydeo

2020

Journal of Digestive Endoscopy

View full text Add to dashboard Cite

Abstract Background The commonest therapeutic indications for double balloon enteroscopy (DBE) includes removal of retained video capsules, dilatation of strictures, polypectomy, and managing obscure small bowel bleeding. We review our experience in managing active small bowel bleeding with DBE. Methods A retrospective review was done for all the cases undergoing DBE from August 2017 to July 2019. Patient follow-up data was collected. Results Among 25 cases with a median age of 46.8 (range 25–65 years), 17 males (68%) underwent DBE for suspected small bowel bleeding. The commonest presenting complaint was melena 19 (76%). The findings were positive (diagnostic yield) in 18 (72%) patients with an antegrade approach. Active bleeding was associated with Dieulafoy's lesion (n = 6), gastrointestinal stromal tumors (GIST) (n = 4), jejunal varices (n = 3), angioectasia (n = 3), and ulcer (n = 2), who then underwent successful intervention. The rest of the patients underwent both antegrade and retrograde approach but failed to immediately identify an alternative diagnosis. Mean (standard deviation [SD]) time taken for antegrade enteroscopy was 96.7 (15.3) mins and 67.8 (13.6) mins for retrograde enteroscopy. The median duration between the last bleeding episode and timing of DBE was 9 (range 6–15 hours). No major complications were seen during or immediately postprocedure. Conclusion DBE is useful in identifying and treating active small bowel bleeding. Being invasive and time-intensive, it is easy to miss lesions and, therefore, needs appropriate expertise. DBE does appear to be relatively cheaper, with better patient acceptance and time saving.

show abstract

“…[ 18 ] However, surgical treatment is often required for patients with large bleeding volume and accurate lesion positioning. [ 19 ] In conclusion, treatment of colonic telangiectasia should be personalized, depending on severity.…”

Section: Discussionmentioning

confidence: 99%

Diffuse telangiectasia of the colon

Zhong²,

Li³

et al. 2020

Medicine

View full text Add to dashboard Cite

Rationale: Colonic telangiectasia, also known as colonic angiodysplasia, refers to arteriovenous malformations that occur in the colon, which are common vascular lesions in the GI tract. Patient concerns: We report a patient, who was admitted to our hospital for colonoscopy. Diagnoses: Under a microscope, all the segments of the whole colon and the varicose veins showed multiple flaky spider-like telangiectasia changes. The blood vessels were radially distributed and converged in the center. The largest blood vessel was about 10 mm in diameter and had a smooth surface with no ulcers, erosion, or bleeding. Interventions: It was recommended that the patient undergo a capsule endoscopy to examine small intestine. Outcomes: The patient did not agree to endoscopy for personal reasons. During the follow-up half a year later, the patient had no melena with normal range of hemoglobin and red blood cell counts. The fecal occult blood test came out negative. Lessons: While the etiology of colonic telangiectasia remains unclear, it is common in the elderly, and is more associated with geriatric conditions and diseases, especially atherosclerotic diseases. Patients who are diagnosed with colonic telangiectasia but are asymptomatic, do not need further treatment. It is usually recommended to monitor the color of stool and check the hemoglobin and fecal occult blood regularly. Colonoscopy is the main method of diagnosis of colonic telangiectasia, and the positive rate is greater than 90%. This procedure should be performed when there is no bleeding or a small amount of bleeding.

show abstract

Diagnosis and therapeutic strategies for small bowel vascular lesions

Cited by 65 publications

References 94 publications

Evaluation of Transcatheter Arterial Embolization in Treating Gastrointestinal Bleeding Due to Angiodysplasia: A Retrospective Study on Twelve Cases

Evaluation of Transcatheter Arterial Embolization in Treating Gastrointestinal Bleeding Due to Angiodysplasia: A Retrospective Study on Twelve Cases

Outcomes of Double Balloon Enteroscopy for Managing Overt Small Bowel Bleeding

Diffuse telangiectasia of the colon

Contact Info

Product

Resources

About