https://www.gastrojournal.org/article/0016-5085(92)91793-4/pdf

Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis.

Several recent advances have been made in the evaluation and management of acute lower gastrointestinal bleeding. This review focuses on the management of lower gastrointestinal bleeding, especially acute severe bleeding. The aim of the study was to critically review the published literature on important management issues in lower gastrointestinal bleeding, including haemodynamic resuscitation, diagnostic evaluation, and endoscopic, radiologic, and surgical therapy, and to develop an algorithm for the management of lower gastrointestinal bleeding, based on this literature review. Publications pertaining to lower gastrointestinal bleeding were identified by searches of the MEDLINE database for the years 1966 to December 2004. Clinical trials and review articles were specifically identified, and their reference citation lists were searched for additional publications not identified in the database searches. Clinical trials and current clinical recommendations were assessed by using commonly applied criteria. Specific recommendations are made based on the evidence reviewed. Approximately, 200 original and review articles were reviewed and graded. There is a paucity of high-quality evidence to guide the management of lower gastrointestinal bleeding, and current endoscopic, radiologic, and surgical practices appear to reflect local expertise and availability of services. Endoscopic literature supports the role of urgent colonoscopy and therapy where possible. Radiology literature supports the role of angiography, especially after a positive bleeding scan has been obtained. Limited surgical data support the role of segmental resection in the management of persistent lower gastrointestinal bleeding after localization by either colonoscopy or angiography. There is limited high-quality research in the area of lower gastrointestinal bleeding. Recent advances have improved the endoscopic, radiologic and surgical management of this problem. However, treatment decisions are still often based on local expertise and preference. With increased access to urgent therapeutic endoscopy for the management of acute upper gastrointestinal bleeding, diagnostic and therapeutic colonoscopy can be expected to play an increasing role in the management of acute lower gastrointestinal bleeding.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2036.2005.02485.x

Review article: the management of lower gastrointestinal bleeding

SummaryBackground
Angiodysplasia (AD) of the gastrointestinal (GI) tract is an important condition that can cause significant morbidity and –rarely – mortality.

Aim
To provide an up-to-date comprehensive summary of the literature evaluating this disease entity with a particular focus on pathogenesis as well as current and emerging diagnostic and therapeutic modalities. Recommendations for treatment will be made on the basis of the current available evidence and consensus opinion of the authors.

Methods
A systematic literature search was performed. The search strategy used the keywords ‘angiodysplasia’ or ‘arteriovenous malformation’ or ‘angioectasia’ or ‘vascular ectasia’ or ‘vascular lesions’ or ‘vascular abnormalities’ or ‘vascular malformations’ in the title or abstract.

Results
Most AD lesions (54–81.9%) are detected in the caecum and ascending colon. They may develop secondary to chronic low-grade intermittent obstruction of submucosal veins coupled with increased vascular endothelial growth factor-dependent proliferation. Endotherapy with argon plasma coagulation resolves bleeding in 85% of patients with colonic AD. In patients who fail (or are not suitable for) other interventions, treatment with thalidomide or octreotide can lead to a clinically meaningful response in 71.4% and 77% of patients respectively.

Conclusions
Angiodysplasia is a rare, but important, cause of both overt and occult GI bleeding especially in the older patients. Advances in endoscopic imaging and therapeutic techniques have led to improved outcomes in these patients. The choice of treatment should be decided on a patient-by-patient basis. Further research is required to better understand the pathogenesis and identify potential therapeutic targets.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/apt.12527

Review article: gastrointestinal angiodysplasia - pathogenesis, diagnosis and management.

Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis.

Stigmata of hemorrhage in bleeding peptic ulcers: an interobserver agreement study among international experts

With the aim of evaluating, in a controlled prospective fashion, the efficacy of monopolar electrocoagulation in the emergency treatment of bleeding gastric and stomal ulcers, 37 patients were studied: 16 were electrocoagulated (EC group) while the remaining 21 were treated by conventional methods (control group). The hemorrhage recurred in only one of the 16 patients belonging to the EC group, but in 11 of the 21 control patients (p less than 0.0005). Transfusion requirements were also reduced in the EC group (p less than 0.05), with no significant difference in relation to mortality. Stratifying the results according to hemorrhagic activity, electrocoagulation should be clearly effective in those patients with spurting hemorrhage, taking into account several limitations: deep ulcers bearing gross vessels, and lack of cooperation by the patient. Prophylactic treatment of the bleeding ulcer with a visible non-spurting vessel may be indicated whenever we make a proper selection of the patients with a greater possibility of hemorrhagic recurrence.

Efficacy of monopolar electrocoagulation in the treatment of bleeding gastric ulcer: a controlled trial.

Having reviewed 47 cases of vascular malformations of the stomach and duodenum, we propose an endoscopic classification for these lesions: Pattern I (flat or slightly protruded, bright red lesions with frond-like margin) is the most usual form of presentation. The "telangiectatic form" (pattern II) is an endoscopic variation, with the same clinical and, possibly, pathogenic significance. Submucosal nodular forms (pattern III) are the most difficult to diagnose and treat. Electrocoagulation is the most pertinent treatment.

Vascular malformations of the stomach and duodenum: an endoscopic classification.

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Efficacy of monopolar electrocoagulation in the treatment of bleeding gastric ulcer: a controlled trial.

Vascular malformations of the stomach and duodenum: an endoscopic classification.