A novel method of treating colonic angiodysplasia
ABSTRACT Colonic angiodysplasia is responsible for up to a third of lower-GI bleeding cases. Argon plasma coagulation (APC) is a recognized treatment modality, but active bleeding decreases the ablative efficacy of APC by dissipation of the energy. APC has been associated with colonic perforation.
We propose a novel and safe method for the treatment of colonic angiodysplasia by a submucosal injection of a saline epinephrine solution followed by the application of APC.
Three patients with a total of 10 colonic angiodysplasias were treated with this injection-APC method.
Saline adrenaline solution (1:200,000) 2 to 3 mL was injected beneath the angiodysplasia before application of APC. APC 50 W and gas flow 2 L were applied onto the vascular lesion until the sufficient thermal effect was observed.
There were no procedure-related complications.
This new injection-APC method was safe for the treatment of colonic angiodysplasia. This may be useful in treating right-sided colonic lesions where the risks of perforation are greater than for the rest of the colon.
- SourceAvailable from: Jean L Holley
[Show abstract] [Hide abstract]
- "Angiodysplasias are treated locally with Argon plasma coagulation (APC)  or bipolar/heater probe . Angiography may permit localization of a large bleeding lesion with therapeutic embolization or injection of vasopressin . "
ABSTRACT: Gastrointestinal (GI) bleeding is more common in patients with chronic kidney disease and is associated with higher mortality than in the general population. Blood losses in this patient population can be quite severe at times and it is important to differentiate anemia of chronic diseases from anemia due to GI bleeding. We review the literature on common causes of lower gastrointestinal bleeding (LGI) in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. We suggest an approach to diagnosis and management of this problem.10/2011; 2011:272535. DOI:10.4061/2011/272535
- [Show abstract] [Hide abstract]
ABSTRACT: In case of spontaneous gastrointestinal bleeding or bleeding related to endoscopic therapy the aim of management is to stop definitively the bleeding. Such a success avoids others more invasive hemostatic modalities and is associated with better prognosis. Efficient endoscopic hemostatic devices are injections of diluted epinephrine or cyanoacrylate in case of portal hypertension, thermal methods (thermocoagulation and argon plasma coagulation) and mechanical methods (hemoclipping, banding ligation, endoloop). Therapeutic options are mainly depending on the size and the cause of the bleeding, if bleeding is active or not, but not on location at upper, lower or mild intestine. Endoscopic devices are more often used for therapeutic hemostasis than for prevention; however, for prevention of bleeding, clips and endoloop are more adapted. Injection therapy with dilute epinephrine is very easy to do, very efficient at least for a short time, without morbidity and is a good way to stop bleeding before possible complementary treatment. Thermal methods are associated with a low risk of perforation. Plasma argon coagulation is more and more used but is not useful in case of active bleeding. Hemoclipping with one or more clips is often efficient, and brings about no tissular lesions and clips are easily eliminated. In case of rebleeding after initial endoscopic success, endoscopic retreatment is associated with definitive hemostasis in about 80% of cases. Mots clés Hémorragie digestive endoscopie thérapeuti- que hémostase endoscopique
- [Show abstract] [Hide abstract]
ABSTRACT: Summary In summary, when taking care of a pregnant woman, one must not forget that her well-being has priority over that of her fetus. We must take particular care with regard to left lateral positioning and early definitive airway management. We must initiate Caesarean delivery at 4 minutes into cardiac arrest to improve the chance of survival of a neurologically intact mother and baby. Lastly, we must integrate the care of the parturient in ACLS and ICU protocols in spite of inadequate research, and we must not be afraid to investigate and properly treat an acutely ill pregnant woman.