DOPPLER CONTROLLED DIAGNOSIS AND TREATMENT OF GASTROINTESTINAL ANGIODYSPLASIA

In 19 of 532 consecutive patients with intestinal bleeding, 47 vascula r malformations were found endoscopically as the source of the hemorrh age (3.6%). Eleven angiodysplasias were located in the gastroduodenum and 36 in the colorectum. In all patients, bleeding had stopped sponta neously before endoscopy was performed. To detect superficial arterial vessels responsible for the hemorrhage all lesions were scanned by tr ansendoscopic Doppler ultrasound. There were 41 Doppler-positive anoma lies (87%) and 6 Doppler-negative anomalies without an arterial signal . All malformations with submucosal arterial blood flow were treated b y prophylactic injection therapy. Control Doppler ultrasound two weeks later revealed the presence of a vessel in 4 angiodysplasias followed by a second sclerotherapy. The 6 Doppler negative lesions could not b e found on control examination and corresponded probably to temporary traumatic or inflammatory mucosal changes. Within the framework of fol low-up over three months, 2 patients rebled (10,5%). A second scleroth erapy resulted in no further hemorrhage. Endoscopic Doppler ultrasound may help in identification and treatment of gastrointestinal angiodys plasias. After identification of blood vessels responsible for hemorrh age, Doppler ultrasound enables monitoring of local endoscopic therapy .