ETHANOLAMINE INJECTION FOR SCLEROTHERAPY OF ANGIODYSPLASIA OF THE COLON

Background and Study Aims: Endoscopic sclerotherapy has been a very us eful method for the management of bleeding vascular lesions of the gas trointestinal tract. In this report, the injection of a sclerosant age nt was evaluated for the treatment of angiodysplasias of the colon. Pa tients and Methods: In a prospective study in eight patients an ethano lamine solution was injected under endoscopic observation directly int o 15 lesions, typically angiodysplasias of the right colon at the inde x colonoscopy, and into another eight de novo lesions found at subsequ ent examinations. The needle injector was intended to be placed very c arefully into the lesion, tangentially to the mucosal surface, to avoi d penetrating the bowel wall. Results: Clinical follow-up showed that in six out of the eight patients (75 %) no further evidence of lower i ntestinal hemorrhage was registered after the sclerotherapy; follow-up ranged from 22 to 36 months. Of the four patients who needed blood tr ansfusion before the treatment because of intestinal bleeding, only on e required blood transfusion after the sclerotherapy. Neither immediat e 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 quad rant pain after the injection, which subsided without am medication. C onclusions: Our method was shown to be feasible and safe. The success of the intralesional injection of the sclerosing agent may be predicte d when changes in the mucosal surface are observed: (a) immediately af ter the injection sufficient sclerosant is deemed to have been injecte d and to the proper depth in the bowel wan, if the mucosa bulges while the solution is being injected; and (b) if a shallow ulceration is se en in an early subsequent reexamination where the treated lesion was L ocated, allowing scar tissue produced by the healing process of the ul cer to replace the former vascular lesion.