polidocanol and Angiodysplasia

To investigate the effectiveness of prophylactic injection therapy in vascular malformations after acute hemorrhage. To review recent advances in diagnosis and treatment control of bleeding intestinal angiodysplasias with an endoscopic Doppler device.. Open prospective study involving 34 patients with bleeding from gastroduodenal and colorectal angiodysplasias.. In order to detect the superficial arterial vessels responsible for the bleeding, a total of 79 lesions were scanned by transendoscopic Doppler ultrasonography. 70 vascular ectasias (88.6%) were Doppler-positive and had injection therapy with epinephrine and polidocanol.. Out of the 70 sclerosed angiodysplasias, 63% (90.0%) could not be found endoscopically 2 weeks later, confirming the success of therapy. Doppler noise was still recorded in 7 visible malformations, indicating insufficient treatment. Further injections were made into these lesions, and the vascular anomalies were finally eliminated. During 1 year of follow-up, 2 of the 34 treated patients (5.88%) relapsed with actively bleeding cecal angiodysplasias. After repeated endoscopic hemostasis, no more hemorrhage was observed in both patients. The results were partly published in previous publications.. Endoscopic Doppler ultrasonography may help in identification and treatment of intestinal angiodysplasias. The technically simple method allows objective evaluation of the endoscopic findings and enables monitoring of local endoscopic therapy.

Topics: Adult; Aged; Aged, 80 and over; Angiodysplasia; Epinephrine; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerotherapy; Ultrasonography, Doppler

Two cases of bleeding gastric angiodysplasia treated with a different approach, on the basis of the endoscopic features, are reported. Arteriovenous malformations may arise from any site of the digestive tract: gastric angiodysplasia represents one of the less frequent localizations, causing 2-5% of upper gastrointestinal bleeding. Several diagnostic tools are currently available and the choice of the most appropriate therapeutic strategy depends on many features: site and number of the lesions, patient's hemodynamic conditions, endoscopic skill. Surgery is preferred only when multiple and disseminated lesions within the gastric wall occur or when endoscopic approach fails.

Topics: Angiodysplasia; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Stomach; Stomach Diseases

The term angiodysplasia (AD) refers to acquired malformation of the blood vessels (communications between veins and capillaries), frequently found within the gastrointestinal mucosa and submucosa. AD of stomach and duodenum are cause of upper gastrointestinal bleeding in 4%-7% of patients. The means of treatment are usually endoscopic, including argon plasma coagulation (APC), electrocoagulation, mechanical hemostasis by clippsing, laser photo-coagulation and injection therapy.. To compare the success rate, and adverse events (ulcer lesions, perforations) of APC and injection therapy in the treatment of bleeding angiodysplasia in the upper gastrointestinal tract (GIT).. In a prospective study including 50 patients with bleeding angiodysplasia of the upper GIT, 35 patients were treated with APC, and remaining 15 with injection therapy using adrenaline and 1.5% solution of polidocanol. Follow-up period was 6 months.. A total of 50 patients aged 18 to 64 years, 64% male and 36% female, have been treated during 2 years period. The rate of recurrent bleeding and side effects was significantly higher in the adrenaline group (p <0.01). Blood transfusion was required in 68% during the first hospital admission. Angiodysplasia of the stomach was present in 66%, versus 34% in duodenum.. Endoscopy is "gold standard" for diagnosis and treatment of AD in the gastrointestinal tract. The study unveiled APC as more effective treatment option with lower degree of complications and adverse events in comparison to injection therapy in patients with bleeding AD.

Topics: Adult; Angiodysplasia; Argon Plasma Coagulation; Blood Transfusion; Endoscopy, Gastrointestinal; Epinephrine; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Male; Middle Aged; Polidocanol; Prospective Studies; Sclerosing Solutions; Treatment Outcome; Upper Gastrointestinal Tract; Young Adult

Small-bowel angioectasias are frequently diagnosed with capsule endoscopy (CE) or balloon endoscopy however, major predictors have not been defined and the indications for endoscopic treatment have not been standardized. The aim of this study was to evaluate the predictors and management of small-bowel angioectasia.. Among patients with obscure gastrointestinal bleeding (OGIB) who underwent both CE and double-balloon endoscopy at our institution, we enrolled 64 patients with small-bowel angioectasia (angioectasia group) and 97 patients without small-bowel angioectasia (non-angioectasia group). The angioectasia group was subdivided into patients with type 1a angioectasia (35 cases) and type 1b angioectasia (29 cases) according to the Yano-Yamamoto classification. Patient characteristics, treatment, and outcomes were evaluated.. Age (P = 0.001), cardiovascular disease (P = 0.002), and liver cirrhosis (P = 0.003) were identified as significant predictors of small-bowel angioectasia. Multivariate logistic regression analysis identified cardiovascular disease (odds ratio 2.86; 95% confidence interval, 1.35-6.18) and liver cirrhosis (odds ratio 4.81; 95% confidence interval, 1.79-14.5) as independent predictors of small-bowel angioectasia. Eleven type 1a cases without oozing were treated conservatively, and 24 type 1a cases with oozing were treated with polidocanol injection (PDI). Re-bleeding occurred in two type 1a cases (6%). Seventeen type 1b cases were treated with PDI and 12 type 1b cases were treated with PDI combined with argon plasma coagulation (APC) or clipping. Re-bleeding occurred in five type 1b cases (17%) that resolved after additional endoscopic hemostasis in all cases. There was one adverse event from endoscopic treatment (1.6%).. Cardiovascular disease and liver cirrhosis were significant independent major predictors of small-bowel angioectasia. Type 1a angioectasias with oozing are indicated for PDI and type 1b angioectasias are indicated for PDI with APC or clipping.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Angiodysplasia; Argon Plasma Coagulation; Capsule Endoscopy; Cardiovascular Diseases; Double-Balloon Enteroscopy; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Intestinal Diseases; Intestine, Small; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Risk Factors; Sclerosing Solutions; Young Adult

A 72-year-old man with acute myelocytic leukemia (AML) suffered relapsing massive bleeding from gastric angiodysplasia. He was referred to our hospital in February 2000 because of anemia and thrombocytopenia. He had hypercellular (nucleated cell count 42 x 10(4)/microl) bone marrow with 90% myeloblasts, and AML (FAB: M1) was diagnosed. Remission induction therapy by BHAC/DM regimen failed. While considering subsequent regimens, massive hematemesis from a solitary gastric angiodysplasia developed. In April, after re-remission induction by CAG regimen, hematemesis from the same lesion reccurred. Hemostasis was achieved by topical transendoscopic injection of polidocanol. After achievement of complete remission by CAG therapy, he was treated on an outpatient basis. In July, his AML relapsed and he was treated mainly by transfusion therapy. In September, hematemesis recurred resulting in hemostasis with the same procedure. In the course of endoscopic injections, his mucosal lesion became difficult to observe. Gastric angiodysplasia is occasionally observed in the elderly, but massive bleeding is a rare complication. In this case, topical injection of polidocanol was an effective procedure for the massive bleeding from it even in an elderly patient with the complication of thrombocytopenia due to AML.

Topics: Aged; Angiodysplasia; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Humans; Injections, Intralesional; Leukemia, Myeloid, Acute; Male; Polidocanol; Polyethylene Glycols; Stomach Diseases