Endoscopy as a tool for diagnosing and treating gastrointestinal angiodysplasia in haemodialysis patients

Gastroenteric angiodysplasia is an important cause of haemorrhage in chroni c renal failure patients. This paper reports on 2 patients on maintenance h aemodialysis with upper gastrointestinal bleeding due to different manifest ations of angiodysplasic lesions (sudden appearance of haematemesis and mel aena in one case, progressive anaemia with apparent resistance to erythropo ietin in the other case). Exploratory endoscope examination of the first di gestive tract showed in both cases the presence of bleeding angiodysplasic lesions. Both patients were there and then submitted to surgical endoscopy, during which the bleeding angiodysplasic lesion was sclerosed with physiol ogical salt solution plus adrenaline 1/10000 and 1% polydocanol. In one pat ient, bleeding occurred again ten days later, making renewed surgical endos copy necessary. In the course of this an elastic ligature was made to the s uperangular angiodysplasia. A year later in both cases there were no direct or indirect signs of further bleeding; an endoscopic check-up showed the t reated lesions to be sclerosed. Endoscopy offers the unique possibility of being used for both diagnostic and therapeutic purposes in a single session . In expert hands, endoscope therapy is effective and markedly reduces the risk of side effects.