From the Guidelines
Management of angioectasia involves a combination of endoscopic and medical approaches, with argon plasma coagulation being the preferred endoscopic method and adjunct medical therapy including iron replacement and somatostatin analogues being beneficial in reducing rebleeding rates and improving hemoglobin levels. The approach to managing angioectasia should be individualized based on the severity of bleeding, location, and number of lesions, as well as the patient's comorbidities and tolerance to therapy 1.
Endoscopic Therapy
- Argon plasma coagulation (APC) is the most common form of endoscopic therapy for angioectasias, due to its effectiveness and safety profile 1.
- Other endoscopic options include hemostatic clips and endoscopic sclerosants, which may be used with some evidence of effectiveness 1.
- Radiofrequency ablation is a newer modality of therapy, but is considered experimental and technically challenging, especially in the small bowel 1.
Medical Therapy
- Adjunct medical therapy, including iron replacement and somatostatin analogues, may be beneficial in increasing hemoglobin levels, decreasing transfusion requirements, and reducing hospital admissions secondary to rebleeding 1.
- The choice of oral or IV iron in patients with bleeding gastrointestinal angioectasias depends on the severity of iron depletion, symptoms, and patient tolerance 1.
- Somatostatin analogues, such as octreotide, may reduce the red blood cell transfusion requirement as well as the rebleeding rate in patients diagnosed with small-bowel angioectasias, although the evidence to date is not robust 1.
- Antiangiogenic therapy, such as thalidomide, may be effective in reducing rebleeding rates, but should be reserved for patients who have failed all other forms of therapy and should be given by providers with experience with thalidomide due to its potential adverse reactions 1.
Best Practice Advice
- Endoscopic treatment of angioectasias should be accompanied by iron replacement 2.
- Medical therapy for small-bowel angioectasias should be reserved for compassionate treatment in refractory cases when iron replacement and endoscopic therapy are ineffective 2. The goal of therapy should be to improve quality of life, reduce morbidity and mortality, and minimize the risk of complications related to anemia and bleeding.
From the Research
Management of Angioectasia (Vascular Ectasia)
The management of angioectasia, also known as vascular ectasia, involves various medical and endoscopic therapies. The following are some of the key aspects of its management:
- Medical therapies: + Bevacizumab, an anti-vascular endothelial growth factor antibody, has been shown to be effective in managing chronic bleeding and anemia in hereditary hemorrhagic telangiectasia (HHT) patients with angioectasia 3. + Thalidomide has been found to reduce the number of bleeding episodes in patients with angiodysplasia, but it does not reduce mortality 4. + The combination of estrogen and progesterone has not been shown to significantly reduce bleeding episodes in patients with angiodysplasia, and it may even increase mortality 4.
- Endoscopic therapies: + Argon plasma coagulation (APC) is a safe and effective treatment modality for both angiodysplasia and vascular ectasia bleeding 5. + Endoscopic band ligation has been found to be more effective than APC in treating gastric antral vascular ectasia (GAVE) 4. + Polidocanol injection (PDI) and APC or clipping are indicated for type 1b angioectasias, while PDI is indicated for type 1a angioectasias with oozing 6.
- Diagnostic tools: + Capsule endoscopy is a useful tool for diagnosing small-bowel angioectasia and can contribute to its treatment by identifying the bleeding source 7. + Balloon-assisted endoscopy can be used to perform argon plasma coagulation hemostasis for small intestinal angioectasia 7.
Predictors of Small-Bowel Angioectasia
Certain factors have been identified as predictors of small-bowel angioectasia, including: