Laser treatment of intestinal vascular abnormalities.

Mucosal vascular abnormalities, including haemangioma, angiodysplasia and telangiectasia, are thought to be responsible for one third of chronic lower gastrointestinal blood loss. One hundred and ninety-one patients were referred for endoscopic diagnosis and treatment of acute or chronic blood loss. In 24 (13%) of patients no bleeding source could be found, in 23 (12%) laser treatment was not indicated and in another 23 (12%) follow-up was insufficient. Of 121 evaluable patients, 107 had angiodysplasia with colonic localisation in 54, 9 had telangiectasia diffusely within the digestive tract, and 5 haemangioma with colonic location in 3. In angiodysplasia effective haemostasis was obtained in 78% with a recurrence rate of 34% at prolonged follow-up, which responded to treatment in 82%. In patients with Rendu-Osler-Weber disease the haemostasis rate was 56%, with recurrence occurring in 33% and a retreatment response in 21%. Colonic haemangioma responded in 67% of cases but there was a high recurrence rate of 67% and a low retreatment response (33%). There were five major complications and all occurred with colonic angiodysplasia (5/54, 9.3%). These included serosal irritation (2), CO2 distension (1) and posttreatment bleeding (2). Minor complications consisted of CO2 retention in one case treated for angiodysplasia, and fever (1) and posttreatment bleeding (2) in haemangioma. Effective and safe haemostasis can be obtained by Neodymium-YAG laser-photocoagulation in often difficult circumstances without perforation or mortality. The method has proven to be indispensible for elderly and inoperable patients with intestinal vascular abnormalities.