Do Clinical Characteristics Predict Small Bowel Angiodysplasias On Capsule Endoscopy?

Abstract

Background/Objectives: Angiodysplasias (AVMs) are the most common vascular anomaly found in the gastrointestinal (GI) tract, and these lesions are often associated with obscure GI bleeding. The aim of this study was to investigate whether clinical characteristics, such as age, gender, creatinine, aortic stenosis, or colonic and/or upper GI AVMs, can predict the presence of small bowel (SB) AVMs on capsule endoscopy (CE). Such data could be used to identify patients at high risk for SB AVMs, who may be candidates for proceeding directly to push enteroscopy (PE) or double balloon enteroscopy (DBE) without intervening CE. Methods: We performed a retrospective analysis of patients undergoing CE at the University of Michigan Health System. Inclusion criteria were: (1) complete CE; (2) complete EGD and colonoscopy; and (3) ≥ 1 AVM on EGD or colonoscopy. Exclusion criteria were: (1) history of radiation therapy to the GI tract; and (2) hereditary angiodysplasia syndrome. Data were extracted on: (1) age; (2) gender; (3) baseline creatinine (including need for hemodialysis); (4) history of aortic stenosis; and (5) location of AVMs (gastric, duodenal, jejunal, ileal, and/or colonic). Multivariate logistic regression was used to identify independent clinical risk factors for SB AVMs. Results: 1,125 patients underwent EGD, colonoscopy, and CE. 120 patients (93% with GI blood loss) were found to have 1 or more AVMs on EGD and/or colonoscopy and met inclusion criteria. The mean age was 69 years, and 64% of patients were women. 36% of patients were found to have 1 or more jejunal AVMs, and 15% were found to have 1 or more ileal AVMs. In bivariate analysis, age ≥ 65 (OR 2.79, p = 0.02) and the presence of AVMs on EGD (OR 3.52, p = 0.01) predicted jejunal but not ileal AVMs. In a multivariate model including age, gender, creatinine, history of aortic stenosis, and presence of AVMs on traditional endoscopy, age ≥ 65 (OR 2.63, p = 0.05) and presence of AVMs on EGD (OR 5.56, p = 0.01) were significant predictors of jejunal AVMs. AVMs on colonoscopy alone were not predictive of jejunal or ileal AVMs. No factors were found to predict the presence of ileal AVMs. Conclusion: Patients with AVMs on EGD are at increased risk for jejunal AVMs on CE, particularly if they are elderly. In these patients, it may be reasonable to bypass CE and proceed directly to therapeutic SB enteroscopy (PE or DBE) if blood loss persists after treatment of AVMs on EGD. Future studies should validate these findings in a prospective cohort.