Diagnosis and therapeutic strategies for small bowel vascular lesions

Small bowel vascular lesions, including angioectasia (AE), Dieulafoy's lesion (DL) and arteriovenous malformation (AVM), are the most common causes of obscure gastrointestinal bleeding. Since AE are considered to be venous lesions, they usually manifest as a chronic, well-compensated condition....

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2019-06, Vol.25 (22), p.2720-2733
Main Authors: Sakai, Eiji, Ohata, Ken, Nakajima, Atsushi, Matsuhashi, Nobuyuki
Format: Article
Language:English
Subjects:
Anemia - diagnosis
Anemia - etiology
Anemia - therapy
Angiodysplasia - complications
Angiodysplasia - diagnosis
Angiodysplasia - therapy
Argon Plasma Coagulation
Capsule Endoscopy
Gastrointestinal Hemorrhage - diagnosis
Gastrointestinal Hemorrhage - etiology
Gastrointestinal Hemorrhage - therapy
Hemostatic Techniques
Humans
Intestine, Small - blood supply
Intestine, Small - diagnostic imaging
Iron - administration & dosage
Review
Treatment Outcome
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Summary:Small bowel vascular lesions, including angioectasia (AE), Dieulafoy's lesion (DL) and arteriovenous malformation (AVM), are the most common causes of obscure gastrointestinal bleeding. Since AE are considered to be venous lesions, they usually manifest as a chronic, well-compensated condition. Subsequent to video capsule endoscopy, deep enteroscopy can be applied to control active bleeding or to improve anemia necessitating blood transfusion. Despite the initial treatment efficacy of argon plasma coagulation (APC), many patients experience re-bleeding, probably because of recurrent or missed AEs. Pharmacological treatments can be considered for patients who have not responded well to other types of treatment or in whom endoscopy is contraindicated. Meanwhile, a conservative approach with iron supplementation remains an option for patients with mild anemia. DL and AVM are considered to be arterial lesions; therefore, these lesions frequently cause acute life-threatening hemorrhage. Mechanical hemostasis using endoclips is recommended to treat DLs, considering the high re-bleeding rate after primary APC cauterization. Meanwhile, most small bowel AVMs are large and susceptible to re-bleeding therefore, they usually require surgical resection. To achieve optimal diagnostic and therapeutic approaches for each type of small bowel lesion, the differences in their epidemiology, pathology and clinical presentation must be understood.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v25.i22.2720