Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: A critical review and view points

Figure 1 Pathogenesis of gastrointestinal angiodysplasias. VEGF: Vascular endothelial growth factor; vWF: Von Willebrand factor; CRF: Chronic renal failure.

Figure 2 Endoscopic characteristics of small bowel angiodysplasias by video capsule endoscopy. A: Patchy lesion with non-pulsatile active bleeding (arrow) (Type 1 lesion); B: Non-bleeding lesion with central excavated ulcer (circle) (Type 2 lesion); C: Bright red patchy spot (arrow) (Type 3 lesion); D: Pale red spot (arrow) (Type 4 lesion). (García-Compeán D et al).

Figure 3 Selective embolization of small bowel vascular bleeding lesion by angiography. A: Selective catheterization of jejunal branch of superior mesenteric artery revealed a bleeding angiodysplasia (arrow); B: Super selective catheterization of bleeding-vessel using micro catheter; C: Angiogram after embolization revealed complete disappearance of active bleeding (arrow).

Figure 4 Treatment of actively bleeding angiodysplasia (Type 1) in gastric fundus with argon plasma coagulation. A: Before coagulation; B: During coagulation, note the jet of ionized argon gas from the probe without contact with the vascular lesion (arrow); C: After coagulation (García-Compeán D et al).

Figure 5 Practical guide for treatment of gastrointestinal angiodysplasias based on their localization, clinical manifestations and endoscopic type lesion. Small bowel angiodysplasias are separately considered due to their difficult accessibility. ¹Hemostatic treatment; ²Prophylactic treatment; ³Consider adequate surgical risk patients with focalized lesions; ⁴Type 1 (actively bleeding) and Type 2 (with bleeding stigmata); ⁵Type 3 (bright red spots); ⁶Alternate use of procedures.