Commentary

Faced with colonic angioectasia, especially with multiple lesions, we tend to reach for the argon plasma coagulation (APC) probe. However its variable depth penetration and effectiveness give rise to concerns about potential complications and recurrence. Geyl et al. [1] nicely illustrate a previously described technique, focused on treating the deeper submucosal origin of these vascular lesions. Whereas APC treats by spreading from the surface to the deeper layers, resection of the mucosal “cap” centered on the angioectasia reveals the true culprit – larger submucosal feeding vessels, which can then be approached directly ([Fig. 1]). Logically, exposing the submucosa and delivering highly targeted treatment should improve cure rates. Nevertheless, one is left to wonder whether resection, as the authors ask in the title of their E-Video, is indeed “optimal,” especially when a multitude of lesions is encountered. Complications due to APC are rare and not always clinically relevant. But while APC is a “point-and-shoot” technique, the expertise needed for submucosal treatment of the bleeding caused by resection is altogether different. Footing the bill for injection needle, snare, coagulation forceps, and clips might also make one cautious about this otherwise attractive treatment option.

Fig. 1 Treatment effect of argon plasma coagulation (APC) and hot-snare resection on gut layers and the vascular lesion. Left panel: “Overhead” view of angioectasia and APC effect. Right panels: Cross-section showing expected reach of APC versus hot-snare resection on gut layers and vessels.

Publication History

Article published online:
29 November 2022

• Reference

• 1 Geyl S, Albouys J, Schaefer M. et al. Is endoscopic mucosal resection optimum for treating colonic angiodysplasia?. Endoscopy 2022; DOI: 10.1055/a-1750-9105.