Embolotherapy for small bowel angiodysplasia

Occult bleeding of small bowel: endovascular embolization and literature review

“…Extravasation of the contrast medium representing active bleeding can be demonstrated in between 6% to 20% of patients only 19 . The three other angiographic signs, listed from the most common (90%) to the least (60%), and also from the early stage to the late one are as follows: first; densely opacified, dilated, tortuous and slowly emptying intramural veins; next, a vascular tuft representing dilated mucosal venules and capillaries in the arterial phase and at the latest stage, arteriovenous communication due to precapillary sphincter loss 9 . Angiography also has the potential to become a therapy as well as a diagnostic tool in the treatment of vascular lesions by endovascular embolization.…”

“…About 21 cases of endovascular embolization of angiodysplasias have been reported to date, most of which were performed in colonic segments. Microcoils, microspheres, polyvinyl alcohol (PVA) particles and gelfoam were used as embolic agents in the treatment 4–9 . The physical and biological properties of embolic agents affect their level of occlusion, which constitutes the heart of the matter in the endovascular embolization of angiodysplasias.…”

“…To the best of our knowledge, only three cases of endovascular embolization as the sole procedure or primary treatment method in the management of GI bleeding due to small bowel angiodysplasia have been reported 7–9 . Ikuta et al.…”

“…Nguyen et al. 9 presented an endovascular embolization of jejunal angiodysplasia with 300–500‐µm sized microspheres. In this report the patient made an uneventful recovery after an embolization, with no clinical signs of small intestinal ischemia or infarction.…”

“…Endovascular embolization as a treatment of choice is also not well established in small bowel angiodysplasia in contrast to gastric and colonic angiodysplasia 4–6 . In only a limited number of case reports was an endovascular embolization reported as the sole procedure or primary treatment method 7–9 . The safety of this procedure for small bowel angiodysplasia remains unknown.…”