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Diagnosis and therapeutic strategies for small bowel vascular lesions

Eiji Sakai1, Ken Ohata1, Atsushi Nakajima2

  • 1Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.

World Journal of Gastroenterology
|June 26, 2019
PubMed

Insights

Small bowel vascular lesions like angioectasia, Dieulafoy

Area of Science:

  • Gastroenterology and Endoscopy
  • Vascular Medicine
  • Digestive Diseases

Background:

  • Small bowel vascular lesions are common causes of obscure GI bleeding.
  • Angioectasia (AE) are venous, often chronic; Dieulafoy's lesions (DL) and arteriovenous malformations (AVM) are arterial, causing acute hemorrhage.
  • Understanding lesion-specific characteristics is crucial for effective management.

Purpose of the Study:

  • To differentiate diagnostic and therapeutic strategies for small bowel vascular lesions.
  • To highlight optimal approaches for angioectasia, Dieulafoy's lesions, and arteriovenous malformations.
  • To improve patient outcomes in obscure GI bleeding.

Main Methods:

  • Review of current literature on small bowel vascular lesions.
  • Comparison of treatment modalities including endoscopy, surgery, and pharmacotherapy.
  • Analysis of lesion-specific epidemiology, pathology, and clinical presentation.

Main Results:

  • Angioectasia management involves deep enteroscopy, APC, or medical therapy; re-bleeding is common.
  • Dieulafoy's lesions benefit from mechanical hemostasis (endoclips) due to high re-bleeding after APC.
  • Small bowel AVMs often require surgical resection due to size and re-bleeding risk.

Conclusions:

  • Tailored diagnostic and therapeutic strategies are essential for small bowel vascular lesions.
  • Distinguishing between venous (AE) and arterial (DL, AVM) lesions guides treatment selection.
  • Optimal management requires understanding the unique features of each lesion type.

Keywords:
AngiodysplasiaAngioectasiaArgon plasm coagulationArteriovenous malformationDeep enteroscopyDieulafoy’s lesionObscure gastrointestinal bleedingVideo capsule endoscopy

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