High variation in treatment strategies for gastrointestinal angiodysplasias

Grooteman, Karina V.; Geenen, Erwin J M van; Drenth, Joost P.H.

doi:10.1097/meg.0000000000000673

Cited by 11 publications

(4 citation statements)

References 16 publications

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“…Management of bleeding angioectasias is a challenge and there is no formal guideline available. 13 14 Treatment may be divided into hemostatic, rescue therapy (when all treatment fails) and prophylactic. First-line hemostatic treatment is endoscopic (mechanical/thermal-contact [monopolar/bipolar) and noncontact APC (Argon plasma coagulation)/laser].…”

Section: Discussionmentioning

confidence: 99%

Multifocal Small Bowel Angioectasias: Managed with Innovative, Nonresectional Surgical Procedure

Ghosh¹,

Singh

Rahul

et al. 2022

Surg J (N Y)

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Gastrointestinal (GI) angioectasias/angiodysplasias are the most frequent vascular lesions of GI tract, responsible for ∼5 to 6% of GI bleedings. It commonly involves the small bowel, making it difficult to diagnose and manage endoscopically. Though medical management has been used to prevent bleeding, it has only a limited role in acute severe hemorrhage. In such cases, surgical resection remains the only practical option. However, multiple lesions pose a unique challenge, as resection may not be advisable for long length of bowel involvement. Here, we report a case of recurrent GI bleeding due to multifocal small bowel angioectasias who was managed by a novel technique of full-thickness transmural sutures under intraoperative enteroscopic guidance. At 6 months follow-up, no new bleeding episodes were observed.

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Section: Discussionmentioning

confidence: 99%

Multifocal Small Bowel Angioectasias: Managed with Innovative, Nonresectional Surgical Procedure

Ghosh¹,

Singh

Rahul

et al. 2022

Surg J (N Y)

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“…At present, one of the major issues in clinical management of asymptomatic angiodysplasias is that evidence on treatment outcome is based on heterogeneous small and often non-controlled studies [18–22, 50–54]. This results in considerable practice variation [55]. More understanding of the different risk profiles of patients with different severity of the disease helps to make the right decision in whether to treat and which treatment modality would be needed.…”

Section: Discussionmentioning

confidence: 99%

A Risk Assessment of Factors for the Presence of Angiodysplasias During Endoscopy and Factors Contributing to Symptomatic Bleeding and Rebleeds

et al. 2019

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BackgroundFew studies have assessed factors associated with angiodysplasias during endoscopy or factors associated with symptomatic disease.AimsTo evaluate risk factors for the presence of and contribution to symptomatic disease in patients with angiodysplasias.MethodsWe performed a systematic MEDLINE, EMBASE and Cochrane Library search according to the PRISMA guidelines for studies assessing risk factors involved in angiodysplasias detected during endoscopy and factors that lead to anemia or overt bleeding. Study quality was assessed with the Newcastle–Ottawa scale. A risk assessment was performed by selecting risk factors identified by two independent studies and/or by a large effect size.ResultsTwenty-three studies involving 92,634 participants were included. The overall quality of the evidence was moderate. Risk factors for the diagnosis of angiodysplasias during endoscopy confirmed by at least two studies were increasing age (OR 1.09 per year, 95% CI 1.04–1.1), chronic kidney disease (OR 4.5, 95% CI 1.9–10.5) and cardiovascular disease (2.9, 95% CI 1.4–6.2). The risk of rebleeds was higher in the presence of multiple lesions (OR 4.2, 95% CI 1.1–16.2 and 3.8, 95% CI 1.3–11.3 and 8.6, 95% CI 1.4–52.6), liver cirrhosis (OR 4.0, 95% 1.1–15.0) and prothrombin time < 30% (OR 4.2, 95% 1.1–15.4) with a moderate effect size. Multiple comorbidities were associated with an increased in-hospital mortality (OR 2.29, 95% CI 1.2–4.3).ConclusionsThis systematic review identified age, chronic kidney disease and cardiovascular disease as the most important risk factors for the diagnosis of angiodysplasias during endoscopy. Multiple lesions increase the risk of recurrent bleeding.Electronic supplementary materialThe online version of this article (10.1007/s10620-019-05683-7) contains supplementary material, which is available to authorized users.

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“…Bleeding SBADs are more difficult to treat than gastric or colonic angiodysplasias due to their inaccessibility. GIB due to angiodysplasias is a frequent therapy challenge, no treatment guidelines are currently available, and so there is a high variability in the management of these patients[63,64].…”

Section: Treatmentmentioning

confidence: 99%

Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: A critical review and view points

García-Compeán

Cueto-Aguilera

Jiménez-Rodríguez

et al. 2019

WJG

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Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes; nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient’s quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.

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High variation in treatment strategies for gastrointestinal angiodysplasias

Abstract: Identification of risk factors and treatment of ADs vary widely between gastroenterologists in the Netherlands. Further research is needed to create an evidence-based guideline and thereby optimize the management of symptomatic ADs.

Cited by 11 publications

References 16 publications

Multifocal Small Bowel Angioectasias: Managed with Innovative, Nonresectional Surgical Procedure

Multifocal Small Bowel Angioectasias: Managed with Innovative, Nonresectional Surgical Procedure

A Risk Assessment of Factors for the Presence of Angiodysplasias During Endoscopy and Factors Contributing to Symptomatic Bleeding and Rebleeds

Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: A critical review and view points

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