Epidemiología, diagnóstico y tratamiento de las angiectasias gastrointestinales
Publicado
feb 4, 2023
Almetrics
Dimensions
Google Scholar
Camilo Molineros Barón
Paola Andrea Roa Ballestas
https://orcid.org/0000-0002-3970-0237
https://orcid.org/0000-0002-3970-0237
##plugins.themes.bootstrap3.article.details##
Resumen
Las angiectasias son las malformaciones vasculares mas comunes en el tracto gastrointestinal en la población general. Hasta el momento, la patogénesis de este tipo de malformaciones vasculares no ha esclarecida totalmente. Su incidencia ha venido en aumento debido a la mayor disponibilidad de métodos diagnósticos en gastroenterología, principalmente la videocápsula endoscópica (VCE) y la enteroscopia profunda asistida para el estudio del intestino delgado.
La terapia endoscópica es la estrategia de tratamiento inicial más efectiva, sin embargo existen otras alternativas terapéuticas como lo son la terapia farmacológica, la angiografía más embolización selectiva o la resección quirúrgica.
Keywords
Sangrado gastrointestinal, angiodisplasia, ectasia vascular, resangrado, factor de crecimiento endotelial vascular.gastrointestinal bleeding, angiodysplasia, vascular ectasia, rebleeding, vascular endothelial growth factor
References
1. Rockey DC, Koch J, Cello JP, Sanders LL, McQuaid K. Relative frequency of upper gastrointestinal and colonic lesions in patients with positive fecal occult-blood tests. N Engl J Med. 1998 Jul 16;339(3):153-9. https://doi.org/10.1056/NEJM199807163390303
2. Schmit A, Gay F, Adler M, Cremer M, Van Gossum A. Diagnostic efficacy of push-enteroscopy and long-term follow-up of patients with small bowel angiodysplasias. Dig Dis Sci. 1996 Dec;41(12):2348-52. https://doi.org/10.1007/BF02100126
3. Athanasoulis CA, Galdabini JJ, Waltman AC, Novelline RA, Greenfield AJ, Ezpeleta ML. Angiodysplasia of the colon: a cause of rectal bleeding. Cardiovasc Radiol. 1977-1978;1(1):3-13. https://doi.org/10.1007/BF02551967
4. Sami SS, Al-Araji SA, Ragunath K. Review article: gastrointestinal angiodysplasia - pathogenesis, diagnosis and management. Aliment Pharmacol Ther. 2014 Jan;39(1):15-34. https://doi.org/10.1111/apt.12527
5. García-Compeán D, Del Cueto-Aguilera ÁN, Jiménez-Rodríguez AR, González-González JA, Maldonado-Garza HJ. Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: a critical review and view points. World J Gastroenterol. 2019 Jun 7;25(21):2549-2564. https://doi.org/10.3748/wjg.v25.i21.2549
6. Clouse RE, Costigan DJ, Mills BA, Zuckerman GR. Angiodysplasia as a cause of upper gastrointestinal bleeding. Arch Intern Med. 1985 Mar;145(3):458-61
7. Foutch PG, Rex DK, Lieberman DA. Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. Am J Gastroenterol. 1995 Apr;90(4):564-7
8. DeBenedet AT, Saini SD, Takami M, Fisher LR. Do clinical characteristics predict the presence of small bowel angioectasias on capsule endoscopy? Dig Dis Sci. 2011 Jun;56(6):1776-81. https://doi.org/10.1007/s10620-010-1506-9
9. Carey EJ, Leighton JA, Heigh RI, Shiff AD, Sharma VK, Post JK, Fleischer DE. A single-center experience of 260 consecutive patients undergoing capsule endoscopy for obscure gastrointestinal bleeding. Am J Gastroenterol. 2007 Jan;102(1):89-95. https://doi.org/10.1111/j.1572-0241.2006.00941.x
10. 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 Feb;87(2):201-6
11. Boley SJ, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S. On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology. 1977 Apr;72(4 Pt 1):650-60
12. Junquera F, Saperas E, de Torres I, Vidal MT, Malagelada JR. Increased expression of angiogenic factors in human colonic angiodysplasia. Am J Gastroenterol. 1999 Apr;94(4):1070-6. https://doi.org/10.1111/j.1572-0241.1999.01017.x
13. Heyde EC. Gastrointestinal bleeding in aortic stenosis. New Engl J Med. 1958;259(4):196-197.
14. Pate GE, Mulligan A. An epidemiological study of Heyde's syndrome: an association between aortic stenosis and gastrointestinal bleeding. J Heart Valve Dis. 2004 Sep;13(5):713-6.
15. Becq A, Rahmi G, Perrod G, Cellier C. Hemorrhagic angiodysplasia of the digestive tract: pathogenesis, diagnosis, and management. Gastrointest Endosc. 2017 Nov;86(5):792-806. https://doi.org/10.1016/j.gie.2017.05.018
16. Sakai E, Ohata K, Nakajima A, Matsuhashi N. Diagnosis and therapeutic strategies for small bowel vascular lesions. World J Gastroenterol. 2019 Jun 14;25(22):2720-2733. https://doi.org/10.3748/wjg.v25.i22.2720
17. Liao Z, Gao R, Xu C, Li ZS. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc. 2010 Feb;71(2):280-6. https://doi.org/10.1016/j.gie.2009.09.031
18. May A, Färber M, Aschmoneit I, Pohl J, Manner H, Lotterer E, Möschler O, Kunz J, Gossner L, Mönkemüller K, Ell C. Prospective multicenter trial comparing push-and-pull enteroscopy with the single- and double-balloon techniques in patients with small-bowel disorders. Am J Gastroenterol. 2010 Mar;105(3):575-81. https://doi.org/10.1038/ajg.2009.712
19. Takano N, Yamada A, Watabe H, Togo G, Yamaji Y, Yoshida H, Kawabe T, Omata M, Koike K. Single-balloon versus double-balloon endoscopy for achieving total enteroscopy: a randomized, controlled trial. Gastrointest Endosc. 2011 Apr;73(4):734-9. https://doi.org/10.1016/j.gie.2010.10.047
20. Holleran G, McNamara D. An overview of angiodysplasia: management and patient prospects. Expert Rev Gastroenterol Hepatol. 2018 Sep;12(9):863-872. https://doi.org/10.1080/17474124.2018.1503532
21. Yano T, Yamamoto H, Sunada K, Miyata T, Iwamoto M, Hayashi Y, Arashiro M, Sugano K. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc. 2008 Jan;67(1):169-72. https://doi.org/10.1016/j.gie.2007.08.005
22. Junquera F, Quiroga S, Saperas E, Pérez-Lafuente M, Videla S, Alvarez-Castells A, Miró JR, Malagelada JR. Accuracy of helical computed tomographic angiography for the diagnosis of colonic angiodysplasia. Gastroenterology. 2000 Aug;119(2):293-9. https://doi.org/10.1053/gast.2000.9346
23. Wu LM, Xu JR, Yin Y, Qu XH. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: a meta-analysis. World J Gastroenterol. 2010 Aug 21;16(31):3957-63. https://doi.org/10.3748/wjg.v16.i31.3957
24. May A, Friesing-Sosnik T, Manner H, Pohl J, Ell C. Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding. Endoscopy. 2011 Sep;43(9):759-65. https://doi.org/10.1055/s-0030-1256388
25. Samaha E, Rahmi G, Landi B, Lorenceau-Savale C, Malamut G, Canard JM, Bloch F, Jian R, Chatellier G, Cellier C. Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions. Am J Gastroenterol. 2012 Feb;107(2):240-6. https://doi.org/10.1038/ajg.2011.325
26. Olmos JA, Marcolongo M, Pogorelsky V, Herrera L, Tobal F, Dávolos JR. Long-term outcome of argon plasma ablation therapy for bleeding in 100 consecutive patients with colonic angiodysplasia. Dis Colon Rectum. 2006 Oct;49(10):1507-16. https://doi.org/10.1007/s10350-006-0684-1
27. van Cutsem E, Rutgeerts P, Vantrappen G. Treatment of bleeding gastrointestinal vascular malformations with oestrogen-progesterone. Lancet. 1990 Apr 21;335(8695):953-5. https://doi.org/10.1016/0140-6736(90)91010-8
28. Lewis BS, Salomon P, Rivera-MacMurray S, Kornbluth AA, Wenger J, Waye JD. Does hormonal therapy have any benefit for bleeding angiodysplasia? J Clin Gastroenterol. 1992 Sep;15(2):99-103. https://doi.org/10.1097/00004836-199209000-00004
29. Junquera F, Feu F, Papo M, Videla S, Armengol JR, Bordas JM, Saperas E, Piqué JM, Malagelada JR. A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. Gastroenterology. 2001 Nov;121(5):1073-9. https://doi.org/10.1053/gast.2001.28650
30. Jackson CS, Gerson LB. Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis. Am J Gastroenterol. 2014 Apr;109(4):474-83; quiz 484. https://doi.org/10.1038/ajg.2014.19
31. Ge ZZ, Chen HM, Gao YJ, Liu WZ, Xu CH, Tan HH, Chen HY, Wei W, Fang JY, Xiao SD. Efficacy of thalidomide for refractory gastrointestinal bleeding from vascular malformation. Gastroenterology. 2011 Nov;141(5):1629-37.e1-4. https://doi.org/10.1053/j.gastro.2011.07.018
2. Schmit A, Gay F, Adler M, Cremer M, Van Gossum A. Diagnostic efficacy of push-enteroscopy and long-term follow-up of patients with small bowel angiodysplasias. Dig Dis Sci. 1996 Dec;41(12):2348-52. https://doi.org/10.1007/BF02100126
3. Athanasoulis CA, Galdabini JJ, Waltman AC, Novelline RA, Greenfield AJ, Ezpeleta ML. Angiodysplasia of the colon: a cause of rectal bleeding. Cardiovasc Radiol. 1977-1978;1(1):3-13. https://doi.org/10.1007/BF02551967
4. Sami SS, Al-Araji SA, Ragunath K. Review article: gastrointestinal angiodysplasia - pathogenesis, diagnosis and management. Aliment Pharmacol Ther. 2014 Jan;39(1):15-34. https://doi.org/10.1111/apt.12527
5. García-Compeán D, Del Cueto-Aguilera ÁN, Jiménez-Rodríguez AR, González-González JA, Maldonado-Garza HJ. Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: a critical review and view points. World J Gastroenterol. 2019 Jun 7;25(21):2549-2564. https://doi.org/10.3748/wjg.v25.i21.2549
6. Clouse RE, Costigan DJ, Mills BA, Zuckerman GR. Angiodysplasia as a cause of upper gastrointestinal bleeding. Arch Intern Med. 1985 Mar;145(3):458-61
7. Foutch PG, Rex DK, Lieberman DA. Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. Am J Gastroenterol. 1995 Apr;90(4):564-7
8. DeBenedet AT, Saini SD, Takami M, Fisher LR. Do clinical characteristics predict the presence of small bowel angioectasias on capsule endoscopy? Dig Dis Sci. 2011 Jun;56(6):1776-81. https://doi.org/10.1007/s10620-010-1506-9
9. Carey EJ, Leighton JA, Heigh RI, Shiff AD, Sharma VK, Post JK, Fleischer DE. A single-center experience of 260 consecutive patients undergoing capsule endoscopy for obscure gastrointestinal bleeding. Am J Gastroenterol. 2007 Jan;102(1):89-95. https://doi.org/10.1111/j.1572-0241.2006.00941.x
10. 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 Feb;87(2):201-6
11. Boley SJ, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S. On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology. 1977 Apr;72(4 Pt 1):650-60
12. Junquera F, Saperas E, de Torres I, Vidal MT, Malagelada JR. Increased expression of angiogenic factors in human colonic angiodysplasia. Am J Gastroenterol. 1999 Apr;94(4):1070-6. https://doi.org/10.1111/j.1572-0241.1999.01017.x
13. Heyde EC. Gastrointestinal bleeding in aortic stenosis. New Engl J Med. 1958;259(4):196-197.
14. Pate GE, Mulligan A. An epidemiological study of Heyde's syndrome: an association between aortic stenosis and gastrointestinal bleeding. J Heart Valve Dis. 2004 Sep;13(5):713-6.
15. Becq A, Rahmi G, Perrod G, Cellier C. Hemorrhagic angiodysplasia of the digestive tract: pathogenesis, diagnosis, and management. Gastrointest Endosc. 2017 Nov;86(5):792-806. https://doi.org/10.1016/j.gie.2017.05.018
16. Sakai E, Ohata K, Nakajima A, Matsuhashi N. Diagnosis and therapeutic strategies for small bowel vascular lesions. World J Gastroenterol. 2019 Jun 14;25(22):2720-2733. https://doi.org/10.3748/wjg.v25.i22.2720
17. Liao Z, Gao R, Xu C, Li ZS. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc. 2010 Feb;71(2):280-6. https://doi.org/10.1016/j.gie.2009.09.031
18. May A, Färber M, Aschmoneit I, Pohl J, Manner H, Lotterer E, Möschler O, Kunz J, Gossner L, Mönkemüller K, Ell C. Prospective multicenter trial comparing push-and-pull enteroscopy with the single- and double-balloon techniques in patients with small-bowel disorders. Am J Gastroenterol. 2010 Mar;105(3):575-81. https://doi.org/10.1038/ajg.2009.712
19. Takano N, Yamada A, Watabe H, Togo G, Yamaji Y, Yoshida H, Kawabe T, Omata M, Koike K. Single-balloon versus double-balloon endoscopy for achieving total enteroscopy: a randomized, controlled trial. Gastrointest Endosc. 2011 Apr;73(4):734-9. https://doi.org/10.1016/j.gie.2010.10.047
20. Holleran G, McNamara D. An overview of angiodysplasia: management and patient prospects. Expert Rev Gastroenterol Hepatol. 2018 Sep;12(9):863-872. https://doi.org/10.1080/17474124.2018.1503532
21. Yano T, Yamamoto H, Sunada K, Miyata T, Iwamoto M, Hayashi Y, Arashiro M, Sugano K. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc. 2008 Jan;67(1):169-72. https://doi.org/10.1016/j.gie.2007.08.005
22. Junquera F, Quiroga S, Saperas E, Pérez-Lafuente M, Videla S, Alvarez-Castells A, Miró JR, Malagelada JR. Accuracy of helical computed tomographic angiography for the diagnosis of colonic angiodysplasia. Gastroenterology. 2000 Aug;119(2):293-9. https://doi.org/10.1053/gast.2000.9346
23. Wu LM, Xu JR, Yin Y, Qu XH. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: a meta-analysis. World J Gastroenterol. 2010 Aug 21;16(31):3957-63. https://doi.org/10.3748/wjg.v16.i31.3957
24. May A, Friesing-Sosnik T, Manner H, Pohl J, Ell C. Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding. Endoscopy. 2011 Sep;43(9):759-65. https://doi.org/10.1055/s-0030-1256388
25. Samaha E, Rahmi G, Landi B, Lorenceau-Savale C, Malamut G, Canard JM, Bloch F, Jian R, Chatellier G, Cellier C. Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions. Am J Gastroenterol. 2012 Feb;107(2):240-6. https://doi.org/10.1038/ajg.2011.325
26. Olmos JA, Marcolongo M, Pogorelsky V, Herrera L, Tobal F, Dávolos JR. Long-term outcome of argon plasma ablation therapy for bleeding in 100 consecutive patients with colonic angiodysplasia. Dis Colon Rectum. 2006 Oct;49(10):1507-16. https://doi.org/10.1007/s10350-006-0684-1
27. van Cutsem E, Rutgeerts P, Vantrappen G. Treatment of bleeding gastrointestinal vascular malformations with oestrogen-progesterone. Lancet. 1990 Apr 21;335(8695):953-5. https://doi.org/10.1016/0140-6736(90)91010-8
28. Lewis BS, Salomon P, Rivera-MacMurray S, Kornbluth AA, Wenger J, Waye JD. Does hormonal therapy have any benefit for bleeding angiodysplasia? J Clin Gastroenterol. 1992 Sep;15(2):99-103. https://doi.org/10.1097/00004836-199209000-00004
29. Junquera F, Feu F, Papo M, Videla S, Armengol JR, Bordas JM, Saperas E, Piqué JM, Malagelada JR. A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. Gastroenterology. 2001 Nov;121(5):1073-9. https://doi.org/10.1053/gast.2001.28650
30. Jackson CS, Gerson LB. Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis. Am J Gastroenterol. 2014 Apr;109(4):474-83; quiz 484. https://doi.org/10.1038/ajg.2014.19
31. Ge ZZ, Chen HM, Gao YJ, Liu WZ, Xu CH, Tan HH, Chen HY, Wei W, Fang JY, Xiao SD. Efficacy of thalidomide for refractory gastrointestinal bleeding from vascular malformation. Gastroenterology. 2011 Nov;141(5):1629-37.e1-4. https://doi.org/10.1053/j.gastro.2011.07.018
Cómo citar
Molineros Barón, C., & Roa Ballestas, P. A. (2023). Epidemiología, diagnóstico y tratamiento de las angiectasias gastrointestinales. Universitas Medica, 64(1). https://doi.org/10.11144/Javeriana.umed64-1.edta
Número
Sección
Artículos de revisión
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.