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DOI: 10.1055/a-1918-0918
Submucosal dissection of a large colonic angiodysplasia in case of failure of conventional treatment
Digestive angiodysplasias are responsible for about 10 % of lower digestive bleeds and may also be revealed with an iron deficiency-related anemia [1]. They are common in elderly populations with a history of heart disease or anticoagulant medication. The currently recommended treatment is the use of argon plasma. However, this treatment can be associated with significant morbidity, especially for large angiodysplasias where post-procedural hemorrhage or secondary perforations are reported [2].
As shown in [Fig. 1] and [Video 1], we report here the case of a 72-year-old man with a 25-mm large right colonic angiodysplasia, visible on computed tomography (CT) scan at arterial time. This lesion was responsible for recurrent anemia and digestive bleeds, favored by anticoagulant treatment. A treatment with argon had already been performed but the symptomatology had recurred. An endoscopic submucosal dissection (ESD) was therefore proposed for this patient, with success. We feared a possible intense submucosal fibrosis, which is why the dissection was started 15 mm upstream of the angioma in healthy mucosa. This technique allowed penetrating into the submucosal space in order to treat the feeding vessel in a targeted way. We report no complications following the procedure, and 1 month afterward the CT scan confirmed the vanishing of the angiodyplasia.
Video 1 Submucosal dissection of a large colonic angiodysplasia with targeted coagulation of the feeding vessel.
Quality:
Endoscopic mucosal resection has been reported to treat colonic angiodysplasias [3] [4]. However, ESD has the advantage of being able to treat angiodysplasias of more than 20 mm and to coagulate the feeding vessel in a targeted manner.
In experienced hands, ESD allows targeted coagulation of the feeding vessel and seems to be a promising method to treat large colonic angiodysplasias if conventional treatment fails.
Endoscopy_UCTN_Code_TTT_1AQ_2AJ
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Publication History
Article published online:
22 September 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 García-Compeán D, Del Cueto-Aguilera ÁN, Jiménez-Rodríguez AR. et al. Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: a critical review and view points. World J Gastroenterol 2019; 25: 2549-2564
- 2 Triantafyllou K, Gkolfakis P, Gralnek IM. et al. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 850-868
- 3 Sriram N, Bar-Yishay I, Kumarasinghe P. et al. Definitive therapy of colonic angioectasia by submucosal coagulation. Endosc Int Open 2019; 07: E1773-E1777
- 4 Geyl S, Albouys J, Schaefer M. et al. Is endoscopic mucosal resection optimum for treating colonic angiodysplasia?. Endoscopy 2022;