How is upper gastrointestinal bleeding (UGIB) caused by angiodysplasia treated?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

Bleeding from angiodysplasias can range from occult blood loss to life-threatening hemorrhage. Because the lesions are small and superficial, endoscopic therapy is highly successful. Endoscopic treatments and devices used for hemostasis include argon plasma coagulation (APC), contact heat probes, electrocoagulation, and injection therapy.

The contact probe coagulators have been the most common form of endoscopic treatment because of their proven success and ability to target a bleeding lesion tangentially. Similarly, a noncontact option, APC, is very effective with options of a straight firing, side firing, and circumferential firing probes that result in an increased ease of use with targeting these flat and sometimes broad areas of involvement. APC would be the treatment of choice when treating gastric antral vascular ectasia (GAVE), as it allows the endoscopist to apply prompt and effective “painting” of the angiodysplastic lesions in the distal stomach.

Recurrent bleeding can occur from the mucosal injury caused by the coagulation. To overcome the possibility of a delayed hemorrhage, endoscopic band ligation has been applied for hemostasis in nonvariceal gastrointestinal bleeding, including angiodysplasias. [138]

When endoscopic techniques fail, surgical resection becomes necessary. When pangastric involvement is the source of bleeding, a total gastrectomy may be required; however, this is extremely rare. Available nonsurgical options include angiography with catheter-directed vasopressin. Combined hormonal therapy with estrogen and progesterone for patients in whom the diagnosis is unknown and vascular lesions are suggested has not been demonstrated to be effective.


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