Introduction Angiodysplasia is a relatively uncommon cause of acute upper GI bleeding (AUGIB). The aim of this study was to characterise the presentation, management and outcome of this condition.
Methods Retrospective audit of upper GI endoscopies (UGIE) performed at our institution between 1 January 2007 and 30 June 2010. Data were extracted from the endoscopy reporting software (Unisoft) database using search terms “angiodysplasia,” “angioma” and “telangiectasia” for oesophageal, gastric and duodenal diagnoses. These three terms were grouped together as “angiodysplasia” for analysis. The casenotes for all patients presenting with haematemesis and/or melaena were reviewed.
Results During the 42-month period of the audit, a total of 15 482 UGIEs were performed. A diagnosis of upper GI tract angiodysplasia was recorded in 199 procedures, representing 132 patients. Of these, 38 were excluded as they had presented with chronic anaemia and 55 patients had undergone UGIE for other indications. 39 patients had presented with haemetemesis and/or melaena. Of these six were excluded from further analysis as the diagnosis of angiodysplasia was not confirmed at subsequent endoscopy; a further seven patients had co-existing lesions which were thought to have accounted for the bleeding. Therefore, the results are presented for 26 patients; the mean age was 70 yrs (range 34–91) and 15 (59%) were males. Twelve (44%) were taking aspirin/NSAIDs, and five (19%) were on anticoagulant therapy. Mean haemoglobin level at presentation was 9.4 g/dl (range 4.0–14.9). Three (11%) of patients had a past history of AUGIB of unknown source; two (7.4%) of patients had a history of previous bleeding from known angiodysplasia. Von Willebrand's disease was noted in three (11%) of patents; four (14.8%) of patients had documented aortic stenosis, with a further two (7.4%) having had an aortic valve replacement. The 26 patients experienced 42 separate admissions (single admission—18 patients, eight patients >1 admission) with AUGIB during the study period. In 39 (93%) of these episodes the presentation was with melaena, and three (7%) with haematemesis plus melaena. Active bleeding was seen in 13 (30%) of these episodes, with luminal blood present in a further four (9%) cases. Endoscopic therapy with argon plasma coagulation or heater probe was undertaken in 35 (81%) of these episodes. Seven (26%) of the patients required additional therapy with either Octreotide, Thalidomide or Tranexamic Acid for uncontrolled or recurrent bleeding. There were no deaths observed due to GI bleeding.
Conclusion Acute bleeding from upper GI tract angiodysplasia can be managed successfully by endoscopic therapy in the majority of patients, but approximately a third of patients will experience recurrent bleeding requiring additional medical therapy.
Competing interests None declared.
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