Video Endoscopic Sequence 1 of 4.

Angiodysplasia of the Duodenum

 This 72 year-old female has been presented with several
 episodes of melenas, her hemoglobin was 8.3 Gr/dl. the
 upper endoscopy shows this vascular lesion in the second
 portion of the duodenum.

 Aberrant blood vessels are frequently found in the
 gastrointestinal tract, where they are probably more
 common than anywhere else in the body. Some are present
 from birth or develop as part of inherited syndromes, but
 the vast majority are acquired later in life. The reasons for
 the distortion of vascular structures observed with
 advancing age are poorly understood.

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Video Endoscopic Sequence 2 of 4.

Endoscopic Ablation

 Bleeding was controlled using the argon plasma coagulator.

 One of the most common complications associated with
 angiodysplasias is bleeding, which is often occult
 Angiodysplastic lesions of the upper GI tract are an
 increasingly recognized cause of occult and obscure GI
 bleeding.

 The argon plasma coagulator (APC) is a non-contact
 electrocoagulation device that uses high-frequency
 monopolar current conducted to target tissues through
 ionised argon gas to achieve haemostasis or tissue
 ablation. This device may be used to coagulate bleeding
 endoscopically, as an alternative to standard haemostatic
 thermal techniques.

Video Endoscopic Sequence 3 of 4.

 Angiodysplasia is characterized by degenerative vascular
 dilation of the capillary net in the absence of dysplastic
 tissue. On endoscopy, flat or slightly elevated, reddish,
 roundish or starry lesions are observed, measuring
 normally between 2 and 10 mm. Angiodysplasia is a
 frequent cause of unexplained upper gastrointestinal
 bleeding with significant morbidity.

Video Endoscopic Sequence 4 of 4.

A Hiatal Hernia is displays, pallor of the gastric mucosa.

Video Endoscopic Sequence 1 of 3.

Endoscopy of Duodenal Angiodysplasia

 This 80 year-old female, who had presented multiple times,
 black stool to the extent that the hemoglobin had dropped
 to 8 g / dl. An endoscopy was performed finding the exact
 site bleeding that is a vascular lesion in the duodenal bulb. 

Video Endoscopic Sequence 2 of 3.

 Angiodysplasia or arteriovenous malformation (AVM) is
 the most common vascular anomaly of the GI tract.
 Composed of an ectatic, dilated submucosal vein (usually
 multiple occurrences), colonic angiodysplasia is responsible
 for 20 to 30 per cent of cases of acute lower GI bleeding.
 Occurrence is highest in persons over the age of 60, with
 two thirds occurring in persons over 70.

 Angiodysplasia is idiopathic; however, there does appear
 to be an increased incidence inpatients with renal disease
 and those with valvular heart disease. With increasing use
 of anti-platelet agents and anticoagulants, a previously
 innocuous vascular lesion may develop clinically significant
 bleeding. In addition, the development of capsule
 endoscopy and double balloon enteroscopy, has resulted
 in increased identification of bleeding lesions in the small
 bowel.

Video Endoscopic Sequence 1 of 3.

Argon plasma coagulator was used to recurrent bleeding from GI angiodysplasias.

 Endoscopic argon plasma coagulation is both effective and
 safe for prevention of recurrent bleeding from GI
 angiodysplasia. Vascular lesions of the GI tract are
 increasingly recognized as a source of bleeding Argon
 plasma coagulation has been successful in treating a
 variety of vascular lesions. Effective treatment for
 angiodysplasia with the majority of patients responding to
 one treatment session.

 Argon plasma coagulation may be used to coagulate the
 bleeding lesion until a white coagulum is visualised.
 Successful ablation of angiodysplasia results in
 improvement in haemoglobin values and cessation of overt
 bleeding.