Endoscopy 2018; 50(04): S114
DOI: 10.1055/s-0038-1637367
ESGE Days 2018 ePoster Podium presentations
20.04.2018 – Enteroscopy
Georg Thieme Verlag KG Stuttgart · New York

HYBRID-APC FOR TREATMENT OF SMALL BOWEL ANGIODYSPLASIA

S Orlando
1   Center for the Prevention and Diagnosis of Coeliac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
,
F Ferretti
2   Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
,
R Penagini
3   Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
,
M Vecchi
3   Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
,
L Elli
1   Center for the Prevention and Diagnosis of Coeliac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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    Angiodysplasia are common cause of small bowel bleeding, especially in patients older than 50 years. Argon Plasma coagulation (APC) is reported to be an effective treatment for angiodysplasia in stomach, duodenum, small bowel and colon. Considering the reduced thickness of small bowel wall, it could be safer to lift the mucosa before treatment with APC to reduce the risk of thermal injury and perforation. Hybrid-APC (ERBEJET 2) is a dual system able to lift the mucosa with pressure waterjet prior to thermal coagulation with argon plasma and it is indicated for the Barrett's esophagus ablation.

    We report the case of a patient with multiple small bowel angiodysplasia successfully treated by Hybrid-APC system.

    A 59-year-old man affected by Rendu-Olser-Weber disease was admitted due to severe microcytic anemia secondary to multiple duodenal and jejunal angiodysplasia. He underwent push enteroscopy (colonscope PENTAX EC3490TLi) that revealed more than 40 flat angiodysplasia from 3 to 5 mm diameter. The waterjet system of Hybrid-APC was set in “duodenal mode” (effect: 15 mbar) and the argon gas flow was set in the “delicate mode” at 1 L/min. Waterjet system (ERBE vio 200 D) allowed an adequate lifting of the mucosa to facilitate APC. A total of 40 angiodysplasia were treated. The operative endoscopy lasted 35 min and was well tolerated with standard sedation (midazolam 5 mg, meperidine 25 mg). Insertion depth was about 100 cm beyond Treitz ligament. No complications were recorded.

    In conclusion, this case shows, for the first time, that Hybrid-APC could be effective and safe for the treatment of small bowel angiodysplasia, especially when facing a high numbers of lesions.


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