Endoscopic localization and management of colonic bleeding in patients with portal hypertension

In patients with portal hypertension, vascular lesions in the colon may develop that have been collectively termed portal hypertensive colopathy. Endoscopic diagnosis of these lesions is now established, but the management of hemorrhage from them is not. We report five cases of endoscopic management of bleeding colonic vascular lesions in patients with portal hypertension. Endoscopy data from January 1, 1996 to June 30, 1999 identified 158 patients with portal hypertension who underwent colonoscopy. Forty-five of these 158 patients had portal hypertensive colopathy (angiodysplasias or varices). Those who had colonoscopic hemostasis attempted were identified and reviewed. Five patients underwent colonoscopic intervention for bleeding. Initial hemostasis was achieved in four of five cases. Repeat endoscopic intervention was necessary in three of the four cases. One patient required surgery. In patients with portal hypertension, colonic vascular lesions may develop. Hemorrhage from these lesions is rare. Colonoscopy is effective for localization and diagnosis of bleeding vascular lesions and permits simultaneous hemostatic intervention.