Medicine of the Future in America

Embolization of a duodenal arteriovenous malformation: DISCUSSION (Part 2)

duodenal AVM in a patient who may have had HHTThere is only one report describing a duodenal AVM in a patient who may have had HHT, based on a family history of a brother with recurrent GIH attributed to congenital telangiectasias. In non-HHT patients, angiodysplastic lesions are also more commonly reported than AVMs in the duodenum. In one review of 218 patients with bowel AVMs, only five patients were found to have lesions in the duodenum.

Diagnosis of gastrointestinal lesions in HHT can be made by endoscopy, angiography, technetium radionucleotide scan or laparotomy. Telangiectasias are usually easy to identify by endoscopy but they may be difficult to see in patients with profound anemia . Clinically important submucosal AVMs may not be recognized unless they are actively bleeding at the time of endoscopy. Furthermore, the yield may be influenced by the type of endoscopic device used. Traditional end-viewing esophagogastroduodenoscopes (at a length of 110 cm) allow visualization to the distal duodenum, to see beyond that, commercially available enteroscopes (200 cm to 250 cm) may be passed with or without an overtube . In certain cases a side-viewing duodenoscope would be optimal.

Endoscopy is often the initial procedure for treating bowel lesions in patients with HHT. Telangiectasias can be treated by endoscopic thermocoagulation with either bipolar, laser (potassium titanyl phosphate or neodymium:yttrium-aluminum-garnet) or noncontact with argon plasma coagulation . In patients with HHT, heater probe, bipolar electrocoagulation and laser have comparable results in controlling acute bleeds from telangiectasias. Find out more about your chance to get at best online pharmacy.

This entry was posted in Hereditary hemorrhagic telangiectasia and tagged Arteriovenous malformation, Gastrointestinal hemorrhage, Hereditary hemorrhagic telangiectasia.
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