Vascular ectasia. Diagnosis and treatment by colonoscopy

Vascular ectasia is an increasingly recognized cause of gastrointestinal tract bleeding in the elderly. Colonoscopy is assuming an important role in diagnosis and treatment of these lesions. The records of 30 patients who had a diagnosis of vascular ectasia made by colonoscopy have been retrospectively reviewed. The 30 patients included 14 men and 16 women whose median age was 70 years (range, 54 to 89 years). All patients had vascular ectasia of the cecum or ascending colon or both, five patients (16.7%) had multiple lesions, and 18 patients (60%) had associated cardiac, vascular, pulmonary, or renal disease. Of the 27 patients who presented with gastrointestinal tract bleeding, 13 (48.1%) underwent endoscopic fulguration, nine (33.3%) underwent resection, and seven (25.9%) were treated conservatively. Endoscopic fulguration was definitive treatment in 11 of the 27 patients (40.7%). A positive histologic diagnosis of vascular ectasia was made in nine of 15 patients (60%) in whom endoscopic biopsy was performed. In the hands of an experienced endoscopist, colonoscopy is a safe and effective way of diagnosing vascular ectasia and is potentially therapeutic. Endoscopic coagulation should be attempted before operation in patients with chronic anemia, limited bleeding, or concomitant severe medical disease.