Analysis of the Clinical Features and Endoscopic Treatment of Small Intestinal Angiodysplasia Identified by Using Double-Balloon Enteroscopy

Abstract

Background and aims: The endoscopic observation of the small bowel angiodysplasia, one of the important diseases responsible for gastrointestinal bleeding, was technically hampered because of the difficulty of endoscopic approach to the small intestine. Double-balloon endocopy (Fujinon EN-450P5/20, Fuji Photo Optical Co., Ltd., Omiya, Japan), a new insertion method of endoscopy, enables wide range of endoscopic observation in the small intestine. The aim of this study was to evaluate the clinical features of the 8 cases of small intestinal angiodysplasia. Endoscopic treatment was also carried out in most of the patients and the outcomes of the treatment were also evaluated. Methods: We had 8 consecutive patients with small intestinal angiodysplasia from 99 patients that have underwent double-balloon enteroscopy because of the gasteointestinal bleeding between September 2000 and October 2003 at Jichi medical school hospital in Japan. The average age of these 8 patients was 62.3 (31 to 74); 3 men and 5 women. Conventional EGD and colonoscopy were performed before the enteroscopy in all cases studied. Double-balloon enteroscopy was performed from oral approach alone in 2 patients, anal approach alone in one patient, and both approach in 5 patients. Results: The average period from the onset of bleeding to the diagnosis was 65 months (11 days to 30 years). The angiodysplasia was found in 3rd portion of the duodenum in 3 patients, jejunum in 2 patients, and ileum in 5 patients including terminal ileum in 4 patients (duplicated). The lesion was single in 2 patients and multiple in 6 patients. The average size of the lesions was 4.0mm (2mm-15mm) and active bleeding was observed in four patients during the endoscopic procedures. Endoscopic treatment was carried out in seven out of the eight patients (87.5%) by using electro-coagulation after saline injection. No complication occurred after the treatments. Although bleeding was controlled in five patients after the endoscopic treatment, we had two patients who re-bled from the angiodysplasia 89 days and 98 days after the initial treatment, respectively. Endoscopic treatments were repeated and control of bleeding was achieved in both cases. Conclusions: Angiodysplasia was found in a various portion of the small intestine and tend to be multiple. Double balloon enteroscopy is useful for the diagnosis as well as control of bleeding from angiodysplasia in the small intestine.