Digestive Diseases and Sciences, Vol. 34, No. 10 (October 1989), pp. 1542-1546 Angiodysplasia Natural History and Efficacy of Therapeutic Interventions JAMES M. RICHTER, MD, MARCI R. CHRISTENSEN, RN, GRAHAM A. COLDITZ, MB, BS, DrPH and NORMAN S. NISHIOKA, MD Angiodysplasia, a disease for which the optimal treatment is uncertain, is a frequent cause of lower intestinal bleeding among older patients. To study the natural history of angiodysplasia and compare the efficacy of medical therapy, endoscopic electrocoagu- lation, and surgery, the course of 101 patients evaluated from 1974 through 1983 at the Massachusetts General Hospital was reviewed. Angiodysplasia caused bleeding that ranged from occult blood in stools to massive hemorrhage and was also observed incidentally in nonbleeding patients. Patients were followed for up to 10 years (mean of 22 months). Rebleeding was defined as evidence of hemorrhage requiring hospital admis- sion, transfusion, or surgery. Thirty-one patients were treated surgically, 19 patients were treated endoscopically, and 36 patients were treated medically. Using life table analysis we observed similar rebleeding rates among medically and endoscopically treated groups. The surgically treated group had a frequency of rebleeding less than half that of the other groups (P = O.15). A multivariate regression analysis failed to identify any factors other than coagulopathy to explain the different incidence of rebleeding in the patients treated by endoscopic electrocoagulation and surgery. KEY WORDS: Angiodysplasia; electrocoagulation; lower gastrointestinal bleeding. With the development of diagnostic angiography, angiodysplasia of the bowel was recognized as a frequent cause of significant lower intestinal bleed- ing, particularly in elderly patients (1-3). Subse- quently, fiberoptic colonoscopy enabled physicians to identify these lesions more easily and provided an opportunity for nonsurgical therapy (4). Favor- able experience with colonoscopic electrosurgery led physicians to apply this technology to the treat- ment of angiodysplasia. There are no controlled studies documenting improvement in the volume or frequency of bleeding nor are there long-term stud- ies of the natural history of angiodysplasia. Previ- Manuscript received June 24, 1988; accepted October 17, 1988. From the Medical Service (Gastrointestinal Unit), Massachu- setts General Hospital and the Channing Laboratories, Harvard Medical School. Address for reprint requests: Dr. James M. Richter, Gastro- intestinal Unit, Massachusetts General Hospital, Boston, Mas- sachusetts 02114. 1542 ous reports of therapy with colonoscopic electroco- agulation include a series by Howard and colleagues reporting 23 consecutive patients treated with electrocoagulation and followed for a mean of 17 months (5, 6). During this follow-up period, ll patients had further bleeding--eight from angiodys- plasia and three from other causes. Three patients subsequently required surgery. Complications in- cluded a delayed perforation and a hemorrhage at the time of initial treatment. Although endoscopic coagulation is a promising technique, its efficacy is limited by the technical ability to reach sufficient numbers of lesions in the colon, to coagulate lesions in the small intestine, and to stay abreast of newly developed lesions. In order to study the natural history of angiodysplasia and to determine the ef- fect of clinical data and therapeutic interventions, we reviewed our experience with a large heteroge- neous group of patients. Digestive Diseases and Sciences, Vol. 34, No. 10 (October 1989) 0163-2116/89/i000-154256.00/0 9 1989 Plenum Publishing Corporation