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Doppler controlled diagnosis and treatment of gastrointestinal angiodysplasia
1Department of Gastroenterology, Academic Medical Hospital, Fulda, Germany.
Insights
Transendoscopic Doppler ultrasound effectively identified gastrointestinal angiodysplasias responsible for bleeding. This imaging technique aids in targeted endoscopic treatment and monitoring, reducing rebleeding rates.
Area of Science:
- Gastroenterology
- Vascular Medicine
- Medical Imaging
Background:
- Vascular malformations, particularly angiodysplasias, are a significant cause of gastrointestinal bleeding.
- Endoscopic diagnosis of angiodysplasias can be challenging, especially when bleeding has ceased.
- Accurate identification of bleeding sources is crucial for effective therapeutic intervention.
Purpose of the Study:
- To evaluate the utility of transendoscopic Doppler ultrasound in detecting superficial arterial vessels in patients with suspected angiodysplasias.
- To assess the efficacy of Doppler-guided prophylactic injection therapy for gastrointestinal angiodysplasias.
- To determine the role of Doppler ultrasound in monitoring treatment response and identifying potential rebleeding sources.
Main Methods:
- A prospective study involving 532 consecutive patients with intestinal bleeding.
- Endoscopic examination to identify vascular malformations.
- Transendoscopic Doppler ultrasound to detect submucosal arterial blood flow in identified lesions.
- Prophylactic injection therapy for Doppler-positive angiodysplasias.
- Follow-up Doppler ultrasound and clinical assessment for treatment efficacy and rebleeding.
Main Results:
- Vascular malformations were identified in 19 patients (3.6%), with 47 lesions found.
- Transendoscopic Doppler ultrasound detected arterial signals in 41 of 47 lesions (87%).
- Prophylactic injection therapy was administered to 41 patients; 4 required a second sclerotherapy.
- Two patients (10.5%) rebled within three months, successfully managed with a second sclerotherapy.
- Doppler-negative lesions were likely transient mucosal changes.
Conclusions:
- Transendoscopic Doppler ultrasound is a valuable tool for identifying gastrointestinal angiodysplasias responsible for hemorrhage.
- Doppler ultrasound facilitates targeted endoscopic treatment and monitoring of therapeutic interventions.
- This imaging modality can improve the management of angiodysplasias, reducing the risk of recurrent bleeding.
Abstract:
In 19 of 532 consecutive patients with intestinal bleeding, 47 vascular malformations were found endoscopically as the source of the hemorrhage (3.6%). Eleven angiodysplasias were located in the gastroduodenum and 36 in the colorectum. In all patients, bleeding had stopped spontaneously before endoscopy was performed. To detect superficial arterial vessels responsible for the hemorrhage all lesions were scanned by transendoscopic Doppler ultrasound. There were 41 Doppler-positive anomalies (87%) and 6 Doppler-negative anomalies without an arterial signal. All malformations with submucosal arterial blood flow were treated by prophylactic injection therapy. Control Doppler ultrasound two weeks later revealed the presence of a vessel in 4 angiodysplasias followed by a second sclerotherapy. The 6 Doppler negative lesions could not be found on control examination and corresponded probably to temporary traumatic or inflammatory mucosal changes. Within the framework of follow-up over three months, 2 patients rebled (10.5%). A second sclerotherapy resulted in no further hemorrhage. Endoscopic Doppler ultrasound may help in identification and treatment of gastrointestinal angiodysplasias. After identification of blood vessels responsible for hemorrhage, Doppler ultrasound enables monitoring of local endoscopic therapy.