Diagnosis and treatment control of bleeding intestinal angiodysplasias with an endoscopic Doppler device.

Abstract

Objective: To investigate the effectiveness of prophylactic injection therapy in vascular malformations after acute hemorrhage. To review recent advances in diagnosis and treatment control of bleeding intestinal angiodysplasias with an endoscopic Doppler device.

Design: Open prospective study involving 34 patients with bleeding from gastroduodenal and colorectal angiodysplasias.

Interventions: In order to detect the superficial arterial vessels responsible for the bleeding, a total of 79 lesions were scanned by transendoscopic Doppler ultrasonography. 70 vascular ectasias (88.6%) were Doppler-positive and had injection therapy with epinephrine and polidocanol.

Results: Out of the 70 sclerosed angiodysplasias, 63% (90.0%) could not be found endoscopically 2 weeks later, confirming the success of therapy. Doppler noise was still recorded in 7 visible malformations, indicating insufficient treatment. Further injections were made into these lesions, and the vascular anomalies were finally eliminated. During 1 year of follow-up, 2 of the 34 treated patients (5.88%) relapsed with actively bleeding cecal angiodysplasias. After repeated endoscopic hemostasis, no more hemorrhage was observed in both patients. The results were partly published in previous publications.

Conclusion: Endoscopic Doppler ultrasonography may help in identification and treatment of intestinal angiodysplasias. The technically simple method allows objective evaluation of the endoscopic findings and enables monitoring of local endoscopic therapy.