Should I repeat a procedure (fit) after being diagnosed with angiodysplasia?

Should You Repeat FIT After Angiodysplasia?

No, you should not routinely repeat fecal immunochemical testing (FIT) after angiodysplasia has been identified and treated, as the diagnosis has already been established and further management should focus on direct visualization and treatment rather than stool-based screening tests.

Rationale for Not Repeating FIT

Once angiodysplasia has been diagnosed as the source of gastrointestinal bleeding, the clinical approach shifts from screening to surveillance and management of a known lesion. FIT is a screening tool designed to detect occult blood and prompt further investigation—a purpose already fulfilled once angiodysplasia is identified 1, 2.

Appropriate Follow-Up Strategy After Angiodysplasia

Monitor for Recurrent Bleeding Clinically

• Track hemoglobin levels and symptoms rather than stool tests, as angiodysplasia commonly causes recurrent bleeding requiring repeat intervention 2, 3
• Patients with angiodysplasia have a 7.4% recurrence rate after initial endoscopic treatment, though this is significantly lower than other vascular lesions like GAVE 4
• Clinical indicators of rebleeding include overt hematochezia, melena, or progressive iron-deficiency anemia despite treatment 1, 2

Repeat Direct Visualization When Indicated

• Repeat endoscopy (colonoscopy or upper endoscopy) is recommended when there is evidence of recurrent bleeding based on clinical symptoms, hemoglobin drop, or transfusion requirements 5
• Timing matters: If bleeding recurs, repeat endoscopy should be performed promptly rather than waiting for FIT results, as active bleeding increases diagnostic yield 5
• Video capsule endoscopy may be considered if conventional endoscopy is negative but bleeding persists, particularly for small bowel angiodysplasia 5

Risk Factors for Recurrent Bleeding

Certain patients are at higher risk and warrant closer surveillance 5, 4:

• Ongoing anticoagulant use significantly increases rebleeding risk
• Multiple angiodysplasia lesions on initial examination
• Duration of bleeding >3 months before initial diagnosis
• Age >60 years is associated with higher recurrence rates

Why FIT Is Not Useful After Diagnosis

FIT Cannot Guide Treatment Decisions

• A positive FIT after known angiodysplasia simply confirms what is already known—that a bleeding source exists—without providing information about lesion activity, size, or need for intervention
• A negative FIT does not exclude active disease, as angiodysplasia bleeding is often intermittent, and FIT has limited sensitivity for small-volume or intermittent bleeding 1, 3

Direct Visualization Is Superior

• Colonoscopy remains the gold standard for both diagnosis and treatment of colonic angiodysplasia, with endoscopic therapy (particularly argon plasma coagulation) achieving hemostasis in 85% of patients 1, 4
• Angiography has 100% specificity for angiodysplasia diagnosis when contrast extravasation is seen, though sensitivity is only 30-47% 5

Common Pitfalls to Avoid

• Do not delay repeat endoscopy waiting for FIT results if clinical bleeding is evident—hemodynamic instability or ongoing transfusion requirements warrant immediate investigation 5
• Do not assume a single treatment session is sufficient: Some patients require multiple endoscopic sessions, particularly those with extensive lesions 4
• Do not overlook small bowel sources: If colonic evaluation is negative but bleeding continues, small bowel angiodysplasia accounts for 30-40% of obscure GI bleeding and requires capsule endoscopy or enteroscopy 3, 5

Practical Management Algorithm

1. After initial angiodysplasia treatment: Monitor hemoglobin and symptoms clinically every 3-6 months
2. If hemoglobin drops ≥4 g/dL or overt bleeding recurs: Proceed directly to repeat endoscopy without FIT 5
3. If chronic low-grade bleeding persists: Consider repeat colonoscopy or capsule endoscopy rather than FIT 5
4. If completely asymptomatic with stable hemoglobin: Continue clinical surveillance without routine FIT or endoscopy

The key principle is that FIT serves as a screening tool to prompt investigation, not as a surveillance tool after a bleeding source has been identified and treated 1, 2.