G A Bemvenuti1, M M Jülich. 1. Dept. of Internal Medicine, Hospital de Clinicas de Porto Alegre Universidade Federal do Rio Grande do Sul, RS, Brazil. gabe@pro-via-rs.com.br
Abstract
BACKGROUND AND STUDY AIMS: Endoscopic sclerotherapy has been a very useful method for the management of bleeding vascular lesions of the gastrointestinal tract. In this report, the injection of a sclerosant agent was evaluated for the treatment of angiodysplasias of the colon. PATIENTS AND METHODS: In a prospective study in eight patients an ethanolamine solution was injected under endoscopic observation directly into 15 lesions, typically angiodysplasias of the right colon at the index colonoscopy, and into another eight de novo lesions found at subsequent examinations. The needle injector was intended to be placed very carefully into the lesion, tangentially to the mucosal surface, to avoid penetrating the bowel wall. RESULTS: Clinical follow-up showed that in six out of the eight patients (75%) no further evidence of lower intestinal hemorrhage was registered after the sclerotherapy; follow-up ranged from 22 to 36 months. Of the four patients who needed blood transfusion before the treatment because of intestinal bleeding, only one required blood transfusion after the sclerotherapy. Neither immediate nor late complications were recorded; often light bleeding occurred immediately after the injections and stopped spontaneously, except in one case which necessitated additional injection of the sclerosant. On the other hand, only one patient had light transient right lower quadrant pain after the injection, which subsided without any medication. CONCLUSIONS: Our method was shown to be feasible and safe. The success of the intralesional injection of the sclerosing agent may be predicted when changes in the mucosal surface are observed: (a) immediately after the injection sufficient sclerosant is deemed to have been injected and to the proper depth in the bowel wall, if the mucosa bulges while the solution is being injected; and (b) if a shallow ulceration is seen in an early subsequent reexamination where the treated lesion was located, allowing scar tissue produced by the healing process of the ulcer to replace the former vascular lesion.
BACKGROUND AND STUDY AIMS: Endoscopic sclerotherapy has been a very useful method for the management of bleeding vascular lesions of the gastrointestinal tract. In this report, the injection of a sclerosant agent was evaluated for the treatment of angiodysplasias of the colon. PATIENTS AND METHODS: In a prospective study in eight patients an ethanolamine solution was injected under endoscopic observation directly into 15 lesions, typically angiodysplasias of the right colon at the index colonoscopy, and into another eight de novo lesions found at subsequent examinations. The needle injector was intended to be placed very carefully into the lesion, tangentially to the mucosal surface, to avoid penetrating the bowel wall. RESULTS: Clinical follow-up showed that in six out of the eight patients (75%) no further evidence of lower intestinal hemorrhage was registered after the sclerotherapy; follow-up ranged from 22 to 36 months. Of the four patients who needed blood transfusion before the treatment because of intestinal bleeding, only one required blood transfusion after the sclerotherapy. Neither immediate nor late complications were recorded; often light bleeding occurred immediately after the injections and stopped spontaneously, except in one case which necessitated additional injection of the sclerosant. On the other hand, only one patient had light transient right lower quadrant pain after the injection, which subsided without any medication. CONCLUSIONS: Our method was shown to be feasible and safe. The success of the intralesional injection of the sclerosing agent may be predicted when changes in the mucosal surface are observed: (a) immediately after the injection sufficient sclerosant is deemed to have been injected and to the proper depth in the bowel wall, if the mucosa bulges while the solution is being injected; and (b) if a shallow ulceration is seen in an early subsequent reexamination where the treated lesion was located, allowing scar tissue produced by the healing process of the ulcer to replace the former vascular lesion.
Authors: Richard Brill; Eva Brill; Wibke Uller; Veronika Teusch; Hubert Gufler; Simone Hammer; Claudia Fellner; Katja Evert; Constantin Goldann; Maximilian Helm; Jonas Rosendahl; Walter A Wohlgemuth Journal: Sci Rep Date: 2019-12-27 Impact factor: 4.379