Time to Consider Medical Therapy for Small-Bowel Angioectasias

Abstract

To the Editor: We read with great interest the article written by Samaha et al. (1) regarding the usage of argon plasma coagulation for patients with small-bowel vascular lesions. Management of patients with obscure gastrointestinal bleeding (OGIB) remains a challenge for gastroenterologists. OGIB secondary to angioectasia accounts for approximately 5% of all gastrointestinal bleeding (2). Treatment of actively bleeding or non-bleeding angioectasia with argon plasma coagulation or electrocoagulation has been demonstrated in many studies to be effective as a short-term form of therapy. However, as this current article and other studies have shown, approximately 40–50% of patients with small-bowel angioectasias demonstrate rebleeding or recurrent anemia when followed over time (3,4). Patients most likely to demonstrate recurrent bleeding are those with co-morbid conditions, including cardiovascular, pulmonary and renal disorders, and those with high transfusional requirements before deep enteroscopy (5).