Are Colonic Angiodysplasia a Frequent Cause of Brisk Lower Intestinal Bleeding?

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Background/Aims: Estimates of colonic angiodysplasia (AVMs) as a source of acute lower intestinal bleeding range from 5-40%. The aims of this study were to gather population-based data on the prevalence and treatment of bleeding colonic AVMs, and to identify predictors of active bleeding. Methods: Colonoscopy reports with documented AVMs generated between January 2000 and December 2002 were retrieved from the Clinical Outcomes Research Initiative (CORI) national endoscopic database. Data were collected on patient and hospital demographics, as well as exam findings. Multiple logistic regression was used to identify risk factors for active bleeding. Results: Of the 229,727 unique patients undergoing colonoscopy, a total of 1804 (0.79%) were found to have AVMs. The mean age of patients with AVMs was 68 years (±12.2); 53% of patients were male, 84% were Caucasian, and 15% had an American Association of Anaesthetists (ASA) score of ≥ III. AVMs were more common in the proximal colon: cecum 42%, ascending 21%, transverse 7%, descending and sigmoid 20%, rectum 8%. Among patients with AVMs, common exam indications included hematochezia (25%), occult blood in stool (19%) and anemia (19%). Only 47 patients with AVMs (3%) underwent inpatient colonoscopy for evaluation of hematochezia. Active bleeding was noted at the time of endoscopy in 114 patients with AVMs (6.3%). 48 of the bleeding AVMs (42%) and 164 of the total AVMs (9%) were treated endoscopically. Bipolar coagulation (69%) and APC (27%) were the most commonly utilized treatment modalities. Independent risk factors for active bleeding were [OR, 95% CI]: hematochezia (2.8, 1.9-4.3), increasing age (1.03, 1.02-1.05), academic practice setting (1.8, 1.2-2.9) and occult blood in stool (1.8, 1.1-2.8). AVM location was not a predictor of bleeding. Conclusions: Contrary to frequently cited estimates, colonic AVMs do not appear to play a major role in brisk lower intestinal bleeding. Fewer than half of bleeding AVMs receive endoscopic treatment. Older age and hematochezia were the most significant predictors of active bleeding at colonoscopy.