Localized Telangiopathy of the Stomach and Duodenum Diagnosed and Treated Endoscopically

Abstract

During the period from January, 1976 to December, 1979 we performed 5000 upper gastrointestinal endoscopic examinations. Of these 650 were for gastrointestinal bleeding. In nine patients we found, endoscopically localized mucosal vascular abnormalities of the stomach and duodenum. Repeated endoscopic examinations were necessary in four cases before the correct diagnosis was made. Three telangiopathies (as we prefer to call them) were found incidentally, and in six cases endoscopy was performed because of gastrointestinal bleeding. In five of the six cases with bleeding, the telangiopathy (TAP) probably was the bleeding lesion. The treatment of choice is endoscopic, either by electrodestruction with mono-polar current, or by removal with a diathermy snare. Neither barium meal x-rays of the upper gastrointestinal tract in five cases, nor exploratory laparotomy in two cases, revealed the telangiopathies. There has been no rebleeding after the treatment, except for one case in which another TAP of the small or large bowel is implicated.

Arteriovenous Malformation of the Stomach

“…The latter are benign neo plasms which must be treated either endoscopically or surgically [33]. But in the other cases, the lesions are often multiple and may disappear spontaneously [13].…”

“…Since Moore placed these AV mal formations in a separate entity, several authors have called attention to their special nature, and we believe that at the gastric level, as well as in the small intestine or in the right colon [30], vascular ectasias may constitute a separate and unique entity. Since the term telangiopathy is used in most inherited diseases, this may provoke some confusion, and the denomination of AV malforma tions or angiodysplasia should be adopted, allowing a morphological and etiological classification to be done [2,16,31,32], At present, gastric localization of angiodysplasia is infrequent when compared to the incidence of the dis ease in the lower intestine [6,10,16,[32][33][34]. However, its real incidence cannot be established, since some of the reported cases are not demonstrated angiographically or histologically, or they are confused with haeman giomas [34], On the other hand, it may be hypothesized that some of the cases reported as hereditary haemor rhagic telangiectasias, in which a vascular lesion is found only in the gastrointestinal tract, could really be angiodysplasias [35,36], Similarly, the case described by Thyssen [37] more closely resembles angiodysplasia than a neoplastic formation.…”

Ileal Arteriovenous Malformation: An Uncommon Cause of Gastrointestinal Hemorrhage

“…Ectasia may be found anywhere in the gastrointestinal tract, from the nasopharynx to the rectum [2][3][4][5]. It may never bleed and be discovered only at autopsy [6].…”