Capsule Endoscopy and Double-Balloon Enteroscopy in the Management of Patients with Portal Hypertension and Obscure Gastrointestinal Bleeding

Abstract

Objective: As the specific lesions of esophagus, stomach, and colon in portal hypertension patients, esophageal and gastric varices, gastric antral vascular ectasia, ectopic varices, portal hypertensive gastropathy and colonopathy. However, small intestinal lesions in portal hypertension are not known. The purpose of this study was to investigate these lesions in patients with portal hypertension who underwent capsule endoscopy or/and double-balloon enteroscopy (DBE) for suspected small intestinal hemorrhage and indicate the management of these lesions. Subjects and Methods: Of 112 patients who underwent capsule endoscopy for suspected small intestinal hemorrhage (obscure gastrointestinal bleeding) between December 2003 and October 2006, 23 had portal hypertension. Results: There were eleven males and twelve females with a mean age of 67 years. Angiodysplasia was noted in 11 patients, erosion in 6, blackish solution in 2, no abnormal findings in 2, and others in 2. The 15 of 23 patients underwent DBE because others had no bleeding findings and symptoms after capsule examination. In the 3 of 11 cases with angiodysplasia and the 3 of 6 cases with erosions, bleeding was terminated with endoscopic coagulation therapy. Surgical resection was performed for one with jejunal varices and for one with angiodysplastic lesions involving the entire jejunum. Angiodysplasia of the entire small intestine is currently being treated conservatively because of poorly controlled ascites. One patient with multiple small erosions was treated with misoprostol and anemia was cured. Others were conservatively observed. Conclusions: The results in this study suggested that one of the characteristic of the small intestinal bleeding lesions in portal hypertension patients may be vascular lesions. It is necessary to manage the small intestinal vascular lesions as well as the specific lesions of esophagus, stomach, and colon in portal hypertension patients. Localized lesions were manageable endoscopically whereas diffuse ones required surgical intervention. However, the presence of poor hepatic function presumably rendered those lesions refractory to treatment.