Tailored treatment of intestinal angiodysplasia in elderly
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Background: Angiodysplasia of the gastrointestinal tract is an uncommon, but not rare, cause of bleeding and severe anemia in elderly. Different treatments exist for this kind of pathology.Methods: The aim of this work was to study 40 patients treated for intestinal angiodysplasia with two different kind of endoscopic treatments: argon plasma coagulation (APC) and bipolar electrocoagulation (BEC).Results: Age of patients was similar in both groups (76,2 ± 10.8 years vs 74,8 ± 8,7 years, P = 0,005). Angiodysplasia treated were located in small bowel, right colon, left colon, transverse colon and cecum. We analysed number of treatment, recurrence, hospital discharge, needs of blood transfusions before and after endoscopic treatment. Number of treatment was the same in both groups (1,2 ± 0,2 vs 1,1 ± 0,1, P < 0,001). We had more recurrence in patients treated with BEC (4/20 vs 2/20, P < 0,001). Hospital discharge was comparable in both groups (5,3 ± 3,1 days vs 5,4 ± 2,8 years, P < 0.001)Conclusions: Treatment of angiodysplasia in elderly is not easy. Different kinds of treatment could be adopted. APC and BEC are both safe and effective. The choice of a treatment should consider several factors: age, comorbidity, source of bleeding. In conclusion we think that treatment of bleeding for angiodysplasia in elder population should be a tailored treatment.
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-  Draya X, Camusa M, Coelho J, Ozennea V, Marc Pocarda M, Marteaua P: Treatment of gastrointestinal angiodysplasia and unmet needs. Digestive and Liver Disease 2011, 43: 515-5222.[WoS][Crossref]
-  Nardone G, Rocco A, Balzano T: The efficacy of octreotide therapy in chronic bleeding due to vascular abnormalities of the gastrointestinal tract. Aliment Pharmacol Ther 1999, 13:1429-363.[Crossref]
-  Scaglione G, Pietrini L, Russo F: Long-acting octreotide as rescue therapy in chronic bleeding from gastrointestinal angiodysplasia. Aliment Pharmacol Ther 2007, 26:935-424.[Crossref][WoS]
-  Rogers BHG: Endoscopic diagnosis and therapy of mucosal vascular abnormalities of the gastrointestinal tract, occurring in elderly patients and associated with cardiac, vascular and pulmonary disease. Gastrointest Endosc 1980, 26:134-1385.[Crossref]
-  Weaver GA, Alpern HD, Davis JS, Ramsey WH, Reichelderfer M: Gastrointestinal angiodysplasia associated with aortic valve disease: part of the spectrum of angiodysplasia of the gut. Gastroenterology 1979, 77: 1-116.
-  Chiu Y, Lu L, Wu K, Tam W: Comparison of argon plasma coagulation in management of upper gastrointestinal angiodysplasia and gastric antral vascular ectasia hemorrhage. BMC Gastroenterology 2012, 12:677.[WoS][Crossref]
-  Junquera F, Saperas E, Videla S: Long-term efficacy of octreotide in the prevention of recurrent bleeding from gastrointestinal angiodysplasia. Am J Gastroenterol 2007, 102: 254-608.[WoS][Crossref]
-  Gupta N, Longo WE, Vernava AM: Angiodysplasia of the lower gastrointestinal tract: an entity readily diagnosed by colonoscopy and primarily managed nonoperatively. Dis Colon Rectum 1995, 38: 979-829.[Crossref]
-  Cappell MS, Gupta A: Changing epidemiology of gastrointestinal angiodysplasia with increasing recognition of clinically milder cases: angiodysplasia tend to produce mild chronic gastrointestinal bleeding in a study of 47 consecutive patients admitted from 1980-1989. Am J Gastroenterol 1992, 87: 201-610.
-  Canard JM, Vedrenne B: Clinical application of argon plasma coagulation in gastrointestinal endoscopy: has the time come to replace the laser? Endoscopy 2001, 33: 353-711.[Crossref]
-  Askin MP, Lewis BS: Push enteroscopic cauterization: longterm follow-up of 83 patients with bleeding small intestinal angiodysplasia. Gastrointest Endosc 1996, 43: 580-312.[Crossref]
-  Rolachon A, Papillon E, Fournet J: Is argon plasma coagulation an efficient treatment for digestive system vascular malformation and radiation proctitis? Gastroenterol Clin Biol 2000, 24: 1205-1013.
-  Olmos JA, Marcolongo M, Pogorelsky V: Argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias. Gastrointest Endosc 2004, 60: 881-614.[Crossref]
-  Olmos JA, Marcolongo M, Pogorelsky V: Long-term outcome of argon plasma ablation therapy for bleeding in 100 consecutive patients with colonic angiodysplasia. Dis Colon Rectum 2006, 49: 1507-1615.[Crossref]
-  Redondo-Cerezo E, Gómez-Ruiz CJ, Sánchez-Manjavacas N, Viñuelas M, Jimeno C, Pérez-Vigara G, Morillas J, Pérez-García JI, García-Cano J, Pérez-Sola: A. Long-term follow-up of patients with small bowel angiodysplasia on capsule endoscopy. Determinants of a higher clinical impact and rebleeding rate. Rev Esp Enferm Dig 2008, 100: 202-207.16.
-  Lee EW, Laberge JM: Differential diagnosis of gastrointestinal bleeding. Tech Vasc Interv Radiol 2004, 7: 112-2217.[Crossref]
-  Erdozain Sosa JC, Boixeda de Miquel D, Pe´rez-Herna´ndez F:. Intestinal angiodysplasia: a presentation of 7 cases and review of the literature. Rev Esp Enferm Apar Dig 1989, 75: 661-418.
-  Rutgeerts P, Van Gompel F, Geboes K, Vantrappen G, Broeckaert L, Coremans G. Long term results of treatment of vascular malformations of the gastrointestinal tract by neodymium YAG laser photocoagulation. Gut 1985, 25: 586-93.19.[Crossref]
-  Cooperman AM, Kelly KA, Bernatz PE, Huizenga KA. Arteriovenous malformation of the intestine: an uncommon cause of gastrointestinal bleeding. Arch Surg 1972, 104: 284-720.[Crossref]
-  Lau WY, Wong SY, Ngan H, Fan ST, Wong KK: Intra-operative localization of bleeding small intestinal lesions. Br J Surg 1988, 75: 249-5121.[Crossref]
-  Gostout CJ, Bowyer BA, Ahlquist DA, Viggiano TR, Balm RK: Mucosal vascular malformations of the gastrointestinal tract: clinical observations and results of endoscopic neodymium: yttrium-aluminum-garnet laser therapy. Mayo Clin Proc 1988, 63: 993-100322.[Crossref]
-  Monk JE, Smith BA, O’Leary JP: Arteriovenous malformations of the small intestine. South Med J 1989, 82:18-2223.[Crossref]
-  Foutch PG, Rex DK, Lieberman DA: Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. Am J Gastroenterol 1995, 90:564-724.
-  Buchi KN: Vascular malformations of the gastrointestinal tract. Surg Clin North Am 1992, 72: 559-7025.[Crossref]
-  Korzenik JR: Hereditary hemorrhagic telangiectasia and other intestinal vascular anomalies. Gastroenterologist 1996, 4:203-1026.
-  Foutch PG: Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol 1993, 88: 807-18.27.
-  Vakil N, Huilgol V, Khan I: Effect of push enteroscopy on transfusion requirements and quality of life in patients with unexplained gastrointestinal bleeding. Am J Gastroenterol 1997, 92: 425-828.
-  Pennazio M, Santucci R, Rondonotti E: Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: Report of 100 consecutive cases. Gastroenterology 2004, 126: 643-5329.[Crossref]
-  Van Cutsem E, Piessevaux H: Pharmacologic therapy of arteriovenous malformations. Gastrointest Endosc Clin N Am 1996, 6: 819-32.30.
-  Sharma R, Gorbien MJ: Angiodysplasia and lower gastrointestinal tract bleeding in elderly patients. Arch Intern Med 1995, 155: 807-1231.[Crossref]
-  Diggs G, Holub J, Strate L: Factors that contribute to blood loss in patients with colonic angiodysplasia from a populationbased study. Clin Gastroenterol Hepatol. May 2011, 9(5): 10-1632.
-  Masciariello, S., Aprea, G., Amato, B., Persico, M., Persico, G.: Aneurismi delle arterie splancniche | [Visceral aneurysms]. Minerva Chirurgica, 1997, 52 (1-2) : 45-5233.
-  Romano, M., Mainenti, P.P., Imbriaco, M., Tamburrini, O., Salvatore, M.: Multidetector row CT angiography of the abdominal aorta and lower extremities in patients with peripheral arterial occlusive disease: Diagnostic accuracy and interobserver agreement. European Journal of Radiology, 2004, 50 (3) : 303-308 DOI: 10.1016/S0720-048X(03)00118-934.[Crossref]
-  Rispoli C, Rocco N, Iannone L, Amato B : Developing guidelines in geriatric surgery: role of the grade system. BMC Geriatrics 2009, 9 ( SUPPL.1): A9935.[Crossref]
-  Amato, B., Sivero, L., Vigliotti, G., et al.: Surgery for cancer in the elderly: State of the art. Chirurgia (Turin), 2013. 26 (4): 313-315.36.
-  Loffredo, D., Marvaso, A., Ceraso, S., et al. : Minimal invasive surgery in treatment of liver metastases from colorectal carcinomas: Case studies and survival rates. BMC Surgery, 2013; 13 (SUPPL.2), S45. (doi: 10.1186/1471-2482-13-S2- S45)37.[WoS][Crossref]
-  Orlando, G., Gervasi, R., Luppino, I.M., et al. : The role of a multidisciplinary approach in the choice of the best surgery approach in a super-super-obesity case. International Journal of Surgery, 2014, 12, pp. 103-106 [WoS][Crossref]
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