ENDOSCOPIC HEMOSTASIS FOR VASCULAR LESIONS OF THE SMALL INTESTINE

Abstract

Vascular lesions of the small intestine are the major causes of small bowel bleeding, accounting for 23-52% of bleeding. Vascular lesions often occur in patients with underlying diseases, such as cirrhosis, valvular heart disease, and ischemic heart disease, and in those undergoing hemodialysis. A hemostatic procedure is selected based on the Yano-Yamamoto classification, which is an endoscopic classification of vascular lesions of the small intestine based on the presence or absence of pulsation. Type 1a and 1b correspond to angioectasia lesions and are treated by argon plasma coagulation (APC) or polidocanol injection therapy. Type 2a and 2b correspond to Dieulafoy lesions and are treated by clip-hemostasis. Type 3 corresponds to arteriovenous malformation and is treated with surgical resection in principle. The rebleeding rate of small intestinal vascular lesions after endoscopic hemostasis has been reported to be 38.5%. Female sex, hereditary hemorrhagic telangiectasia, heart disease, overt bleeding, multiple lesions, and cirrhosis have been reported as predictors of rebleeding. It is important to prevent bleeding by appropriate follow-up (based on the risk factors present) and management of underlying diseases.