Successful Management of Colonic Angiodysplasia With Endoscopic Mucosal Resection and Argon Plasma Coagulation

BACKGROUND Colonic angiodysplasia is an acquired arteriovenous malformation that mainly occurs in older patients and is routinely managed using argon plasma coagulation (APC). Among the available endoscopic treatment options for angiodysplasia, APC is the most widely used. However, repeat endoscopy may be required because of post-treatment rebleeding after APC. Furthermore, the high prevalence of angiodysplasia in the right colon complicates treatment with APC because ablation in the right colon is associated with a higher risk of gastrointestinal perforation. A well-documented consensus on the endoscopic treatment of colonic angiodysplasia has not been established, given wide variation in treatment strategies. The efficacy of APC remains unclear due to the lack of prospective studies comparing clinical outcomes, including post-treatment rebleeding rates. CASE REPORT This report describes a 73-year-old woman with anemia caused by a colonic angiodysplasia of the cecum that resulted in spontaneous hemorrhage. We successfully managed the case using endoscopic mucosal resection (EMR) and APC, upon recurrence of angiodysplasia after APC. Treatment using EMR combined with clipping showed no angiodysplasia recurrence. CONCLUSIONS This report suggests that EMR has the potential to serve as a standard treatment option for colonic angiodysplasia, similar to APC. The additional use of clipping in combination with APC or EMR may prevent rebleeding, particularly in patients with risk factors for angiodysplasia-induced hemorrhage.