Background and Aims

Recommendations for the treatment of lower GI bleeding do not include bleeding from venous malformations (VMs). The aim of this study was to delineate the usefulness of a novel hybrid intervention (fluoroscopy-guided endoscopic sclerotherapy) for the treatment of symptomatic VMs in the rectosigmoidal colon with bleeding.

Methods

The magnetic resonance images of 421 patients with VM, referred to multicenter vascular anomaly centers from 2009 to 2017, were analyzed retrospectively. Treatment was performed for all patients who experienced bleeding from rectosigmoidal VMs using fluoroscopy-guided endoscopic sclerotherapy with polidocanol foam as a novel approach.

Results

A total of 27 patients displayed VM in the rectosigmoidal area. Eleven of these presented with acute or previous bleeding and received treatment. Active bleeding was observed in 8 patients (72.7%), whereas 3 patients (27.3%) had signs of previous bleeding. Six of the 11 patients had anemia (54.5%). There were no adverse events within 24 hours of the intervention. In a 2-year follow-up period, only 1 patient (9.1%) presented with recurrent bleeding after 13 months and was successfully treated again with fluoroscopy-guided endoscopic sclerotherapy.

Conclusions

Fluoroscopy-guided endoscopic sclerotherapy was shown to be a safe and effective treatment of symptomatic VMs of the rectosigmoidal area. Thus, fluoroscopy-guided endoscopic sclerotherapy should be considered for patients with bleeding from VMs of the rectosigmoid after a comprehensive workup and interdisciplinary case discussion.

中文翻译：

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透视引导下的内窥镜硬化疗法：一种新的混合方法，用于对症性乙状结肠静脉畸形（附视频）。

背景和目标

治疗低胃肠道出血的建议不包括静脉畸形（VMs）引起的出血。这项研究的目的是要描述一种新型的混合干预（荧光镜引导内镜硬化疗法）在出血的直肠乙状结肠结肠中有症状VM的治疗中的作用。

方法

回顾性分析了2009年至2017年的421例VM患者的磁共振图像，这些患者被称为多中心血管异常中心。对于所有从直肠乙状结肠VM出血的患者，均采用荧光检查指导的内镜下硬化疗法和波多克多酚泡沫进行治疗。

结果

共有27例在乙状结肠区域显示VM。其中有十一例出现急性或先前出血并接受了治疗。有8例（72.7％）观察到活动性出血，而3例（27.3％）有先前出血的迹象。11名患者中有6名患有贫血（54.5％）。干预后24小时内未发生不良事件。在2年的随访期中，只有1例患者（9.1％）在13个月后出现复发性出血，并通过荧光镜引导的内镜硬化疗法再次成功治疗。

结论

透视引导下的内窥镜硬化疗法是治疗乙状结肠区域症状性VM的安全有效方法。因此，经过综合检查和跨学科病例讨论后，对于因直肠乙状结肠VM出血的患者，应考虑使用透视引导下的内镜硬化疗法。