How can GI angiodysplasia be treated at angiography or endoscopy to avoid surgical resection?
Angiodysplasias that are actively bleeding, oozing, or a likely cause of recent or chronic GI bleeding may be treated at angiography or endoscopy. At angiography, bleeding angiodysplasias are identified by extravasation of dye. The catheter is snaked close to the angiodysplasia by superselective catheterization and metal coils or gelfoam are released to embolize the vessel feeding the angiodysplasia.
Angiodysplasia can be ablated at endoscopy using high energy delivered via argon plasma coagulation (APC), electrocoagulation (e.g., Bicap or Gold Probe), thermocoagulation (e.g., Heater Probe), or injection sclerotherapy (e.g., sodium tetradecyl sulfate). APC has a high rate of success at preventing rebleeding from angiodysplasia.
When encountering numerous angiodysplasias at endoscopy performed for recent GI bleeding, the practitioner should treat only those angiodysplasias that are actively bleeding or oozing, that have stigmata of recent hemorrhage (an adherent clot), or are unusually large. Angiodysplasias that are small, not actively bleeding, and do not have any stigmata of recent hemorrhage generally do not require endoscopic therapy.