Prevalence and Natural History of Colonic Angiodysplasia among Healthy Asymptomatic People

Objective: The prevalence of colonic angiodysplasia (AD) among healthy asymptomatic people is unknown, and the natural history of these lesions has not been clearly defined. The purpose of our study was to determine prevalence and to review and assess the natural history of AD. Methods: Each of the authors had previously published his own prospective study that involved screening colonoscopy for the detection of neoplasia in asymptomatic adult men and women who had never bled. All pathological lesions diagnosed by endoscopy were recorded, but only data pertaining to polyps were published. We pooled and analyzed the endoscopic findings (raw data) from those studies and assessed the natural history of the lesions by reviewing the medical charts of affected subjects to determine whether bleeding had occurred. Nine hundred sixty‐four patients were evaluated (mean age, 62 yr). All were ≥ 50 yr old (range, 50–79 yr), not anemic, Hemoccult negative, asymptomatic, and had full colonoscopy to the cecum. Results: Eight subjects had AD (prevalence, 0.83%). Lesions in affected individuals were usually small (mean size, 4.0 mm) and most often were located in the right colon (62%). No subject bled, and all maintained a stable hemoglobin (mean, 14.6 g%) with a mean follow‐up of 3 yr. Conclusions: We conclude that 1) colonic AD is uncommon among healthy asymptomatic people (prevalence, 0.83%), 2) lesions are usually small (<10 mm) and are located proximal to the hepatic flexure, 3) the natural history for AD in these people is benign, and the risk of bleeding over a 3‐yr period is low (0% in 3 yr), and 4) because of this low risk, endoscopic treatment for incidental (nonbleeding) AD is unnecessary.