Endoscopy as a Tool for Diagnosing and Treating Gastrointestinal Angiodysplasia in Haemodialysis Patients

Abstract

Gastroenteric angiodysplasia is an important cause of haemorrhage in chronic renal failure patients. This paper reports on 2 patients on maintenance haemodialysis with upper gastrointestinal bleeding due to different manifestations of angiodysplasic lesions (sudden appearance of haematemesis and melaena in one case, progressive anaemia with apparent resistance to erythropoietin in the other case). Exploratory endoscope examination of the first digestive tract showed in both cases the presence of bleeding angiodysplasic lesions. Both patients were there and then submitted to surgical endoscopy, during which the bleeding angiodysplasic lesion was sclerosed with physiological salt solution plus adrenaline 1/10000 and 1% polydocanol. In one patient, bleeding occurred again ten days later, making renewed surgical endoscopy necessary. In the course of this an elastic ligature was made to the superangular angiodysplasia. A year later in both cases there were no direct or indirect signs of further bleeding; an endoscopic check-up showed the treated lesions to be sclerosed. Endoscopy offers the unique possibility of being used for both diagnostic and therapeutic purposes in a single session. In expert hands, endoscope therapy is effective and markedly reduces the risk of side effects.

Structures of porcine β-trypsin–detergent complexes: the stabilization of proteins through hydrophilic binding of polydocanol

“…In particular, we have cocrystallized native porcine -trypsin (BPT) in its orthorhombic form with varying concentrations of a non-ionic detergent, polyoxyethylene (9)-lauryl ether or polydocanol [C 12 ±O±(C±C±O) 9 ]. Polydocanol has a wide range of medical applications, especially in sclerosis (Di Liberato et al, 1999;Cisneros et al, 1998;Aoki et al, 1997;Dell'Abate et al, 1991).…”

Nonvariceal Upper Gastrointestinal Bleeding

“…Al-Mishlab et al recall the fact that Dieulafoys lesions may appear throughout the gastrointestinal tract [2], with several case reports describing rectal and even anal lesions amenable to endoscopic therapy. Renal failure is traditionally associated with arteriovenous malformations [3]; Nozoe and co-workers report two patients receiving hemodialysis who had Dieulafoys lesions in the lower gastrointestinal tract [4], although a persuasive explanation for the causal relationship involved is not available.…”