Wolfgang Miesbach/LinkedIn,Sophie Susen/MHEMO
May 5, 2026, 11:35
Wolfgang Miesbach: How Should We Approach GI Angiodysplasia in VWD?
Wolfgang Miesbach, Professor of Medicine at Frankfurt University Hospital, shared a post on LinkedIn:
”How should we approach GI angiodysplasia in VWD?
This was the topic of an excellent talk by Sophie Susen at the EHA scientific meeting in Florence, highlighting how complex and under‑recognized this problem still is in VWD:
Diagnosis – stepwise
- Start with gastroscopy plus colonoscopy in all patients with overt GI bleeding or otherwise unexplained iron‑deficiency anemia.
- If negative, move to video capsule endoscopy; use deep enteroscopy for targeted therapy of detected small‑bowel angiodysplasia.
Treatment – pragmatic algorithm
- Acute bleed: stabilize, give iron ± transfusion, VWF/FVIII and TXA in VWD, plus endoscopic hemostasis whenever feasible.
- Recurrent bleeding: optimize VWF prophylaxis, accepting that its effect on angiodysplasia is often limited.
- Transfusion‑dependent / refractory cases: add systemic therapy – somatostatin analogues (e.g. octreotide) as first‑line; consider off‑label anti‑angiogenics (thalidomide, lenalidomide, bevacizumab) in carefully selected patients.
- Focal, resistant lesions: discuss angiographic embolization or surgery in a multidisciplinary board.
A structured algorithm that combines modern small‑bowel imaging, tailored VWF management and stepwise systemic therapy is key to reducing rebleeding, transfusions and hospitalizations in VWD patients with angiodysplasia.”
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