Definitive therapy of colonic angioectasia by submucosal coagulation

Nagaraj Sriram; Iddo Bar-Yishay; Priyanthi Kumarasinghe; Ian Yusoff; Dev Segarajasingam; Michael J. Bourke; Spiro Raftopoulos

doi:10.1055/a-0965-6688

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(12): E1773-E1777
DOI: 10.1055/a-0965-6688

Innovation forum

Definitive therapy of colonic angioectasia by submucosal coagulation

Nagaraj Sriram

¹Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

,

Iddo Bar-Yishay

²Department of Gastroenterology, Westmead Public Hospital, Sydney, NSW, Australia

,

Priyanthi Kumarasinghe

³PathWest, Pathology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

,

Ian Yusoff

¹Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

⁴Department of Gastroenterology, Hollywood Private Hospital, Perth, Western Australia, Australia

,

Dev Segarajasingam

¹Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

⁴Department of Gastroenterology, Hollywood Private Hospital, Perth, Western Australia, Australia

,

Michael J. Bourke

²Department of Gastroenterology, Westmead Public Hospital, Sydney, NSW, Australia

⁵University of Sydney, Sydney, NSW, Australia

,

Spiro Raftopoulos

¹Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

⁴Department of Gastroenterology, Hollywood Private Hospital, Perth, Western Australia, Australia

⁶Department of Gastroenterology, Peel Health Campus, Perth, Western Australia, Australia

› Author Affiliations

Abstract

Background and study aims Colonic angioectasia are the most common vascular lesions in the gastrointestinal tract and are among the most common causes for chronic or recurrent lower gastrointestinal bleeding. Endoscopic treatment involves a variety of techniques, all of which focus on destruction of the mucosal abnormality. However, recurrent bleeding after endoscopic treatment is common, with more than one treatment frequently necessary. We report a technique for definitive treatment of colonic angioectasia by targeting the feeding submucosal vessel.

Patients and methods Analogous to endoscopic mucosal resection, a submucosal injection is made beneath the target lesion which is then removed by electrocautery snare resection of the mucosal lesion. The exposed feeding vessel is then destroyed by application of coagulation current. The resection defect is closed by clips.

Results Six patients with a total of 14 colonic angioectasia were treated over the study period. All lesions were destroyed without adverse events.

Conclusion Elevation, hot snare resection and coagulation (ESC) of the visible vessel for treating colonic angioectasia appears safe and effective. Larger prospective comparative studies are required to assess its specific role.

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References

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