Video Endoscopic Sequence 1 of 7.

Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu syndrome).

The images showing here are tiny multiple, telangiectatic vessels 1 mm. across the duodenum Jejuno and ileum.

 This 62-year-old lady has suffered of ferropenic anemia
 during 10 years. Her average hemoglobin has been  of 10.3
 gr/dl, Fecal Occult Blood Test was positive multiple times
 the enteroscopy shows multiple tiny 1 mm. vascular lesions

 Hereditary hemorrhagic telangiectasia (HHT) is a genetic
 condition associated with vascular malformations
 throughout the body. HHT patients commonly present with
 recurrent gastrointestinal bleeding and iron-deficiency
 anemia.

 Gastrointestinal involvement in HHT is common.
 Telangiectasias, the typical vascular anomaly in this
 disease, appear in the intestinal mucosa as an irregular
 distribution of red macules that have been reported to
 range in size from 1 to 10 mm in diameter

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Video Endoscopic Sequence 2 of 7.

Multiple tiny 1 mm. vascular lesions at the jejuno

 Telangiectases in the gastric mucosa of a patient with
 Osler-Weber-Rendu syndrome. The lesions can be seen
 most prominently at the 11-o'clock position proximally.

 The endoscopic evidence of vascular lesions in patients
 with bleeding confirms the role of GI telangiectasias in the
 bleeding episodes. The researchers do not, however,
 address the more frequent scenario of occult GI blood loss
 that occurs without melena or hematemesis, and they may
 have underestimated the role of GI lesions in HHT anemia.

Video Endoscopic Sequence 3 of 7.

 Forms of hereditary hemorrhagic telangiectasia include
 type 1, type 2, type 3, and juvenile polyposis/hereditary
 hemorrhagic telangiectasia syndrome. People with type 1
 tend to develop symptoms earlier than those with type 2,
 and are more likely to have blood vessel malformations in
 the lungs and brain. Type 2 and type 3 may be associated
 with a higher risk of liver involvement. Women are more
 likely than men to develop blood vessel malformations in
 the lungs with type 1, and are also at higher risk of liver
 involvement with both type 1 and type 2. Individuals with
 any form of hereditary hemorrhagic telangiectasia,
 however, can have any of these problems.

Video Endoscopic Sequence 4 of 7.

 Multiple tiny 1 mm. vascular lesions at the jejuno and
 duodenum.

Video Endoscopic Sequence 5 of 7.

Examination revealed capillary telangiectases

Video Endoscopic Sequence 6 of 7

Multiple tiny 1 mm. vascular lesions and subepithelial hemorrhages

 Systemic estrogen-progesterone at doses used for oral
 contraception may eliminate bleeding in symptomatic HHT
 and is a reasonable initial option in fertile women. There is
 no information on possible effects of lower-dose
 estrogen -progesterone used in postmenopausal women
 for hormone replacement therapy. Tamoxifen has
 dramatically eliminated HHT-related bleeding in two
 cases. It is well tolerated in postmenopausal women and
 should be considered for randomized clinical trials.

Video Endoscopic Sequence 7 of 7.

 At the gastric antrum also has some gastric antral vascular
 ectasias and also some tiny 1mm. capillary telangiectases
 that was treated by argon plasma coagulation as well as
 the jejuno and duodenum lesions.

 The concept of Rendu-Osler-Weber disease was first
 proposed by Rendu (1896), Osler (1901), and Weber (1907)
 In most cases a pattern of autosomal dominant inheritance
 is evident, but about 20% develop spontaneously in the
 absence of evidence of genetic transmission.