Video Endoscopic Sequence 1 of 4.

Angiodysplasia of the Duodenum

This 72 year-old female has been presented with several episodes of melenas, her hemoglobin was 8.3 Gr/dl. the upper endoscopy shows this vascular lesion in the second portion of the duodenum.

Aberrant blood vessels are frequently found in the gastrointestinal tract, where they are probably more common than anywhere else in the body. Some are present from birth or develop as part of inherited syndromes, but the vast majority are acquired later in life. The reasons for the distortion of vascular structures observed with advancing age are poorly understood.

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Video Endoscopic Sequence 2 of 4.

Endoscopic Image and Video Clip of Angiodysplasia of the Duodenum

Endoscopic Ablation

Bleeding was controlled using the argon plasma coagulator.

One of the most common complications associated with angiodysplasias is bleeding, which is often occult Angiodysplastic lesions of the upper GI tract are an increasingly recognized cause of occult and obscure GI bleeding.

The argon plasma coagulator (APC) is a non-contact electrocoagulation device that uses high-frequency monopolar current conducted to target tissues through ionised argon gas to achieve haemostasis or tissue ablation. This device may be used to coagulate bleeding endoscopically, as an alternative to standard haemostatic thermal techniques.

Video Endoscopic Sequence 3 of 4.

Endoscopic Image and Video Clip of Angiodysplasia of the Duodenum

Angiodysplasia is characterized by degenerative vascular
dilation of the capillary net in the absence of dysplastic
tissue. On endoscopy, flat or slightly elevated, reddish,
roundish or starry lesions are observed, measuring
normally between 2 and 10 mm. Angiodysplasia is a
frequent cause of unexplained upper gastrointestinal
bleeding with significant morbidity.

Video Endoscopic Sequence 4 of 4.

A Hiatal Hernia is displays, pallor of the gastric mucosa.

Video Endoscopic Sequence 1 of 3.

Endoscopy of Duodenal Angiodysplasia

This 80 year-old female, who had presented multiple times,
black stool to the extent that the hemoglobin had dropped
to 8 g / dl. An endoscopy was performed finding the exact
site bleeding that is a vascular lesion in the duodenal bulb. 

Video Endoscopic Sequence 2 of 3.

Endoscopic Image and Video Clip of Angiodysplasia of the Duodenum

Angiodysplasia or arteriovenous malformation (AVM) is the most common vascular anomaly of the GI tract. Composed of an ectatic, dilated submucosal vein (usually multiple occurrences), colonic angiodysplasia is responsible for 20 to 30 per cent of cases of acute lower GI bleeding. Occurrence is highest in persons over the age of 60, with two thirds occurring in persons over 70.

Angiodysplasia is idiopathic; however, there does appear to be an increased incidence inpatients with renal disease and those with valvular heart disease. With increasing use of anti-platelet agents and anticoagulants, a previously innocuous vascular lesion may develop clinically significant bleeding. In addition, the development of capsule endoscopy and double balloon enteroscopy, has resulted in increased identification of bleeding lesions in the small bowel.

Video Endoscopic Sequence 3 of 3.

Argon plasma coagulator was used to recurrent bleeding from GI angiodysplasias.

Endoscopic argon plasma coagulation is both effective and
safe for prevention of recurrent bleeding from GI
angiodysplasia. Vascular lesions of the GI tract are
increasingly recognized as a source of bleeding Argon
plasma coagulation has been successful in treating a
variety of vascular lesions. Effective treatment for
angiodysplasia with the majority of patients responding to
one treatment session.

Argon plasma coagulation may be used to coagulate the
bleeding lesion until a white coagulum is visualised.
Successful ablation of angiodysplasia results in
improvement in haemoglobin values and cessation of overt
bleeding.