Skip to main content
SpringerLink
Log in

Angiodysplasies digestives

Gastrointestinal angiodysplasia

  • Article Original / Original Article
  • Published:
Acta Endoscopica

Résumé

Les angiodysplasies sont des lésions vasculaires pouvant atteindre tout le tube digestif. Souvent responsables d’un saignement digestif extériorisé ou d’une anémie ferriprive, elles peuvent également être découvertes de façon fortuite au cours d’un examen endoscopique : endoscopie oesogastroduodénale, coloscopie ou vidéocapsule. Le traitement d’hémostase endoscopique est généralement proposé en première intention, par coagulation au plasma argon ou coagulation bipolaire. En cas de récidive précoce ou d’échec de celui-ci, on peut proposer un traitement systémique par analogue de la somatostatine. Les anti-angiogéniques semblent également prometteurs dans cette indication. On manque encore d’études contrôlées pour ces traitements systémiques.

Abstract

Angiodysplasia are vascular lesions that may be present in all segment of gastrointestinal tract. They are often sources of acute gastrointestinal bleeding or iron-deficiency anemia, but can either be asymptomatic. Diagnosis is easy with gastroscopy, colonoscopy or wireless capsule endoscopy. Endoscopic therapy is generally first proposed, with argon plasma coagulation or bipolar coagulation. If early rebleeding or treatment failure occurs, somatostatine long-acting analogue can be proposed. Inhibitor of angiogenesis may be considered as an interesting option in this indication. There are insufficient data to support the general use of pharmacologic therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Wolff WI, Grossman MB, Shinya H. Angiodysplasia of the colon: diagnosis and treatment. Gastroenterology 1977;72:329–333.

    PubMed  CAS  Google Scholar 

  2. Rockey DC, Koch J, Cello JP, Sanders LL, McQuaid K. Relative frequency of upper gastrointestinal and colonic lesions in patients with positive fecal occult-blood tests. N Engl J Med 1998;339:153–159.

    Article  PubMed  CAS  Google Scholar 

  3. Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1997;92:419–424.

    PubMed  CAS  Google Scholar 

  4. Boley SJ, Brandt LJ. Vascular ectasias of the colon—1986. Dig Dis Sci 1986;31(9 Suppl):26S–42S.

    Article  PubMed  CAS  Google Scholar 

  5. Gordon FH, Watkinson A, Hodgson H. Vascular malformations of the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2001;15:41–58.

    Article  PubMed  CAS  Google Scholar 

  6. Saurin J. Les malformations vasculaires acquises du tube digestif. Endoscopie Digestive Interventionnelle. Paris, Doin. 2002.

    Google Scholar 

  7. Leighton JA, Goldstein J, Hirota W, Jacobson BC, Johanson JF, Mallery JS, et al. Obscure gastrointestinal bleeding. Gastrointest Endosc 2003;58:650–655.

    Article  PubMed  Google Scholar 

  8. Ben Soussan E, Antonietti M, Herve S, Savoye G, Ramirez S, Lecleire S, et al. Diagnostic yield and therapeutic implications of capsule endoscopy in obscure gastrointestinal bleeding. Gastroenterol Clin Biol 2004;28:1068–1073.

    Article  PubMed  Google Scholar 

  9. Foutch PG, Rex DK, Lieberman DA. Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. Am J Gastroenterol 1995;90:564–567.

    PubMed  CAS  Google Scholar 

  10. Heyde E. Gastrointestinal bleeding in aortic stenosis. N Engl J Med 1958;259:196.

    Google Scholar 

  11. Greenstein RJ, McElhinney AJ, Reuben D, Greenstein AJ. Colonic vascular ectasias and aortic stenosis: coincidence or causal relationship? Am J Surg 1986;151:347–351.

    Article  PubMed  CAS  Google Scholar 

  12. Regula J, Wronska E, Pachlewski J. Vascular lesions of the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2008;22:313–328.

    Article  PubMed  Google Scholar 

  13. Vincentelli A, Susen S, Le Tourneau T, Six I, Fabre O, Juthier F, et al. Acquired von Willebrand syndrome in aortic stenosis. N Engl J Med 2003;349:343–349.

    Article  PubMed  Google Scholar 

  14. Pounder DJ, Rowland R, Pieterse AS, Freeman R, Hunter R. Angiodysplasias of the colon. J Clin Pathol 1982;35:824–829.

    Article  PubMed  CAS  Google Scholar 

  15. Boley SJ, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S. On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology 1977;72:650–660.

    PubMed  CAS  Google Scholar 

  16. Junquera F, Saperas E, de Torres I, Vidal MT, Malagelada JR. Increased expression of angiogenic factors in human colonic angiodysplasia. Am J Gastroenterol 1999;94:1070–1076.

    Article  PubMed  CAS  Google Scholar 

  17. Canard JM, Vedrenne B. Clinical application of argon plasma coagulation in gastrointestinal endoscopy: has the time come to replace the laser? Endoscopy 2001;33:353–357.

    Article  PubMed  CAS  Google Scholar 

  18. Dray X, Camus M, Coelho J, Ozenne V, Pocard M, Marteau P. Treatment of gastrointestinal angiodysplasia and unmet needs. Dig Liver Dis 2011;43:515–522.

    Article  PubMed  Google Scholar 

  19. Rahmi G, Vahedi K, Gay G, Delvaux M, Lamouliatte M, Filoche B. Suivi à long terme des patients ayant un saignement digestif inexpliqué avec une lésion à la capsule endoscopique et traités durant une entéroscopie. Communication Orale 124. Journées Francophones d’Hépato-gastroentérologie et Oncologie Digestive 2012.

    Google Scholar 

  20. Junquera F, Feu F, Papo M, Videla S, Armengol JR, Bordas JM, et al. A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. Gastroenterology. 2001;121:1073–1079.

    Article  PubMed  CAS  Google Scholar 

  21. Rossini FP, Arrigoni A, Pennazio M. Octreotide in the treatment of bleeding due to angiodysplasia of the small intestine. Am J Gastroenterol 1993;88:1424–1427.

    PubMed  CAS  Google Scholar 

  22. Nardone G, Rocco A, Balzano T, Budillon G. The efficacy of octreotide therapy in chronic bleeding due to vascular abnormalities of the gastrointestinal tract. Aliment Pharmacol Ther 1999;13:1429–1436.

    Article  PubMed  CAS  Google Scholar 

  23. Junquera F, Saperas E, Videla S, Feu F, Vilaseca J, Armengol JR, et al. Long-term efficacy of octreotide in the prevention of recurrent bleeding from gastrointestinal angiodysplasia. Am J Gastroenterol 2007;102:254–260.

    Article  PubMed  CAS  Google Scholar 

  24. Scaglione G, Pietrini L, Russo F, Franco MR, Sorrentini I. Long-acting octreotide as rescue therapy in chronic bleeding from gastrointestinal angiodysplasia. Aliment Pharmacol Ther 2007;26:935–942.

    Article  PubMed  CAS  Google Scholar 

  25. Brown C, Subramanian V, Wilcox CM, Peter S. Somatostatin analogues in the treatment of recurrent bleeding from gastrointestinal vascular malformations: an overview and systematic review of prospective observational studies. Dig Dis Sci 2010;55:2129–2134.

    Article  PubMed  CAS  Google Scholar 

  26. Bauditz J, Schachschal G, Wedel S, Lochs H. Thalidomide for treatment of severe intestinal bleeding. Gut 2004;53:609–612.

    Article  PubMed  CAS  Google Scholar 

  27. Bauditz J, Lochs H, Voderholzer W. Macroscopic appearance of intestinal angiodysplasias under antiangiogenic treatment with thalidomide. Endoscopy 2006;38:1036–1039.

    Article  PubMed  CAS  Google Scholar 

  28. Ge ZZ, Chen HM, Gao YJ, Liu WZ, Xu CH, Tan HH, et al. Efficacy of thalidomide for refractory gastrointestinal bleeding from vascular malformation. Gastroenterology 2011;141:1629–1637.

    Article  PubMed  CAS  Google Scholar 

  29. Richter JM, Christensen MR, Colditz GA, Nishioka NS. Angiodysplasia. Natural history and efficacy of therapeutic interventions. Dig Dis Sci 1989;34:1542–1546.

    Article  PubMed  CAS  Google Scholar 

  30. May A, Friesing-Sosnik T, Manner H, Pohl J, Ell C. Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding. Endoscopy 2011;43:759–765.

    Article  PubMed  CAS  Google Scholar 

  31. Madisch A, Schmolders J, Bruckner S, Aust D, Miehlke S. Less favorable clinical outcome after diagnostic and interventional double balloon enteroscopy in patients with suspected smallbowel bleeding? Endoscopy 2008;40:731–734.

    Article  PubMed  CAS  Google Scholar 

  32. Landi B, Cellier C, Gaudric M, Demont H, Guimbaud R, Cuillerier E, et al. Long-term outcome of patients with gastrointestinal bleeding of obscure origin explored by push enteroscopy. Endoscopy 2002;34:355–359.

    Article  PubMed  CAS  Google Scholar 

  33. Arakawa D, Ohmiya N, Nakamura M, Honda W, Shirai O, Itoh A, et al. Outcome after enteroscopy for patients with obscure GI bleeding: diagnostic comparison between double-balloon endoscopy and videocapsule endoscopy. Gastrointest Endosc 2009;69:866–874.

    Article  PubMed  Google Scholar 

  34. van Tuyl SA, Letteboer TG, Rogge-Wolf C, Kuipers EJ, Snijder RJ, Westermann CJ et al. Assessment of intestinal vascular malformations in patients with hereditary hemorrhagic telangiectasia and anemia. Eur J Gastroenterol Hepatol 2007;19:153–158.

    Article  PubMed  Google Scholar 

  35. Ingrosso M, Sabba C, Pisani A, Principi M, Gallitelli M, Cirulli A et al. Evidence of small-bowel involvement in hereditary hemorrhagic telangiectasis: a caspule-endoscopic study. Endoscopy 2004;36:1074–1079.

    Article  PubMed  CAS  Google Scholar 

  36. Macedo Costa T, Maldonado R, Valente A, Palma R, Raimundo M, Liberato M et al. Hemobilia in hereditary hemorrhagic telangiectasia: an unusual complication of endoscopic retrograde cholangiopancreatography. Endoscopy 2003;35:531–533.

    Article  Google Scholar 

  37. Chu KM, Lai ECS, Ng IO. Hereditary hemorrhagic telangiectasia involving the ampulla of Vater presented with recurrent gastrointestinal bleeding. Am J Gastroenterol 1993;88:1116–1119.

    PubMed  CAS  Google Scholar 

  38. Lazaraki G, Akriviadis E, Pilpilidis I, Parisi I, Tzilves D, Tarpangos A. Low dose of bevacizumab is safe and effective in preventing bleeding episodes in hereditary hemorrhagic telangiectasia. Am J Gastroenterol 2011;106:2204–2206.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service d’hépatogastroentérologie, hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 9 avenue Charles de Gaulle, F-92100, Boulogne-Billancourt, France

    C. Lorenceau-Savale & G. Lesur

Authors
  1. C. Lorenceau-Savale
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Lesur
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Lorenceau-Savale.

About this article

Cite this article

Lorenceau-Savale, C., Lesur, G. Angiodysplasies digestives. Acta Endosc 43, 159–165 (2013). https://doi.org/10.1007/s10190-013-0329-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10190-013-0329-x

Mots clés

Keywords

Search

Navigation