Acute lower gastrointestinal bleeding: SPECIFIC CAUSES OF LGI BLEEDING Part 6
Complication rates of endoscopic therapy of angiodys-plastic lesions range from 4% to 7%, with more complications occurring in patients who undergo heater probe treatment (7%), as opposed to bipolar electrocoagulation (4%). Cecal lesions may have a slightly increased rate of complications secondary to decreased wall thickness that makes it more susceptible to perforation. Delayed rebleeding appears to be more common in patients with abnormal platelet function and those with giant angiomata. These patients often require surgical intervention.
For patients with recurrent bleeding who have lesions that are difficult to treat, are too numerous to be treated with endoscopic therapy or that are presumed to be located within the small intestine, adjunctive therapy with estrogens is suggested. By improving the vascular endothelium and possibly having a primary benefit on coagulation, oral estrogens have been shown to decrease bleeding in select patients, such as those with hereditary hemorrhagic telangiectasia or chronic renal failure. Always a nice way to discover given by the internet’s best pharmacy.
‘Blind hemicolectomy’ is rarely indicated in LGI bleeding. The mortality rate associated with surgical resection ranges from 10% to 50%. This higher risk results from patients who tend to be elderly with multiple coexisting medical problems, including coronary artery disease. Because involvement of small bowel or bilateral colonic angiodysplastic lesions is common, accurate identification of the bleeding site is critical when surgical intervention is being considered.