This lesion was found in the transverse colon of a patient with a change in bowel habit
HOW WILL YOU MANAGE THIS?
■ I will ignore it
Brilliant, so would I !!!
■ Apply APC in the centre
Yes but only if patient has an IDA !
■ Apply APC from the periphery and working inwards
Advocated by some but life's too short!
■ Inject saline below and then apply APC
Overkill I think ...
■ Apply a clip to the centre
Angioectasia (formerly called 'angiodysplasia but of course these are not 'dysplastic'/ pre-malignant) are an acquired vascular malformation associated with advancing age, aortic stenosis, Von Willebrand Disease and chronic kidney disease. If a patient asks me, I usually put it more diplomatically as 'these come with maturity'. Seems kinder!
They are supposedly a little more common on the right than the left side. IF the patient is anaemic, APC is the treatment of choice. I have tried clips but they don't work. Be careful though as APC has been linked with delayed perforation in up to 1% of cases [Olmos J A. Dis Colon Rectum. 2006;49:1507–16]. I turn the APC down to 30 watts only and set the machine to 'pulsed APC'. Even so, please be sensible and stop after a maximum of a few seconds of heat! Some first raise the lesion with saline but first I don't think that this is necessary unless you are careless with the APC and secondly, I runs the risk of the underlying central, feeding vessel not actually getting ablated.
Of course you could also use a 'coagulation grasper' if you are willing to pay €250 for the same outcome. Alternatively, you may consider a 'hot biopsy forceps' but of course these are now 'banned' and could land you in deep trouble if there is problem. Must admit that I use them instead of coagulation graspers because I'm too stingy to pay the €250.
The correct answer in this case is probably not to do anything as the patient is not anaemic (and presumably has never been anaemic in the past). Secondly, I would advocate that you apply heat to the centre of the lesion only as those spidery legs will then disappear as in the example below.
By the way, it's not described in literature but there are actually two types of angioectasia. There are the 'spider naevi like' angioectasia as in the case above but angioectasia more commonly appear as red blobs as in the example below. Must admit that I don't know why. Must have something to do with the aetiology ...