Doppler controlled diagnosis and treatment of gastrointestinal angiodysplasia.

In 19 of 532 consecutive patients with intestinal bleeding, 47 vascular malformations were found endoscopically as the source of the hemorrhage (3.6%). Eleven angiodysplasias were located in the gastroduodenum and 36 in the colorectum. In all patients, bleeding had stopped spontaneously before endoscopy was performed. To detect superficial arterial vessels responsible for the hemorrhage all lesions were scanned by transendoscopic Doppler ultrasound. There were 41 Doppler-positive anomalies (87%) and 6 Doppler-negative anomalies without an arterial signal. All malformations with submucosal arterial blood flow were treated by prophylactic injection therapy. Control Doppler ultrasound two weeks later revealed the presence of a vessel in 4 angiodysplasias followed by a second sclerotherapy. The 6 Doppler negative lesions could not be found on control examination and corresponded probably to temporary traumatic or inflammatory mucosal changes. Within the framework of follow-up over three months, 2 patients rebled (10.5%). A second sclerotherapy resulted in no further hemorrhage. Endoscopic Doppler ultrasound may help in identification and treatment of gastrointestinal angiodysplasias. After identification of blood vessels responsible for hemorrhage, Doppler ultrasound enables monitoring of local endoscopic therapy.

Doppler-controlled injection treatment of Dieulafoy's disease.

Dieulafoy's anomaly is a vascular malformation of the upper stomach, which typically causes massive and recurrent haemorrhage. Emergency endoscopy is the most effective method of diagnosing the disease. Until recently, the therapy of choice was surgical resection. Five patients with spontaneously stopped bleeding from Dieulafoy's ulceration were investigated. Transendoscopic Doppler ultrasound was used to identify arterial blood flow from the lesions. Local injection treatment was performed. Successful therapy resulted in the disappearance of arterial pulsations and no rebleeding occurred. The endoscopic Doppler is of diagnostic value in the evaluation of Dieulafoy's ulcer and enables control of endoscopic sclerotherapy.