Colonoscopy in this 73 year old man for recurrent bleeding reveals multiple angiodysplastic lesions in the right colon. These frond-like lesions are treated using a bipolar cautery device. The recommended published settings are 15 watts with 2-3 second pulses until obliteration. Applications are repeated until the lesion is obliterated and hemostasis is achieved. Note that following the initial cautery application, bleeding from the central feeding vessel becomes pronounced, a possible clue to this lesion's bleeding potential. Repeated applications are required to fully fulgurated the site. The process is continued until all the visible lesions are ablated. Simultaneous pulse irrigation helps sweep away blood and clot. Transmural injury resulting in perforation has been reported but is uncommon.
Peter B. Kelsey, M.D., Harvard Medical School, Massachusetts General Hospital