Abstract
BackgroundSmall bowel angioectasia is reported as the most common cause of bleeding in patients with obscure gastrointestinal bleeding. Although the safety and efficacy of endoscopic treatment have been demonstrated, rebleeding rates are relatively high. To establish therapeutic and follow-up guidelines, we investigated the long-term outcomes and clinical predictors of rebleeding in patients with small bowel angioectasia.MethodsA total of 68 patients were retrospectively included in this study. All the patients had undergone CE examination, and subsequent control of bleeding, where needed, was accomplished by endoscopic argon plasma coagulation. Based on the follow-up data, the rebleeding rate was compared between patients who had/had not undergone endoscopic treatment. Multivariate analysis was performed using Cox proportional hazard regression model to identify the predictors of rebleeding. We defined the OGIB as controlled if there was no further overt bleeding within 6 months and the hemoglobin level had not fallen below 10 g/dl by the time of the final examination.ResultsThe overall rebleeding rate over a median follow-up duration of 30.5 months (interquartile range 16.5–47.0) was 33.8% (23/68 cases). The cumulative risk of rebleeding tended to be lower in the patients who had undergone endoscopic treatment than in those who had not undergone endoscopic treatment, however, the difference did not reach statistical significance (P = 0.14). In the majority of patients with rebleeding (18/23, 78.3%), the bleeding was controlled by the end of the follow-up period. Multiple regression analysis identified presence of multiple lesions (≥3) (OR 3.82; 95% CI 1.30–11.3, P = 0.02) as the only significant independent predictor of rebleeding.ConclusionIn most cases, bleeding can be controlled by repeated endoscopic treatment. Careful follow-up is needed for patients with multiple lesions, presence of which is considered as a significant risk factor for rebleeding.
Highlights
Small bowel angioectasia is reported as the most common cause of bleeding in patients with obscure gastrointestinal bleeding
Only variables identified as being significant with P values of
Our results suggested that rebleeding could be controlled by repeat endoscopic treatment and iron replacement therapy in the majority of patients with small bowel angioectasia, some patients may be unsuitable for endoscopic treatment, as angioectasia is frequently detected in patients older than 60 years of age [32] and is often accompanied by severe comorbidities such as chronic renal failure [40] and cardiac valvular disease [41]
Summary
Small bowel angioectasia is reported as the most common cause of bleeding in patients with obscure gastrointestinal bleeding. To establish therapeutic and follow-up guidelines, we investigated the long-term outcomes and clinical predictors of rebleeding in patients with small bowel angioectasia. Recent studies have revealed that small bowel angioectasia is the most common cause of bleeding, sometimes life-threatening, in patients with OGIB [19,20]. Several studies have demonstrated the safety and efficacy of endoscopic treatment for small bowel angioectasia [21,22], not all patients with OGIB can receive endoscopic treatment, because the procedure is complex and time-consuming. Relatively high rebleeding rates have been reported in patients with small bowel angioectasia [23,24,25,26] and the predictors of rebleeding have not yet been fully clarified. There is a need for therapeutic and follow-up guidelines to be established
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