Abstract
BackgroundSmall-bowel angioectasias are frequently diagnosed with capsule endoscopy (CE) or balloon endoscopy however, major predictors have not been defined and the indications for endoscopic treatment have not been standardized. The aim of this study was to evaluate the predictors and management of small-bowel angioectasia.MethodsAmong patients with obscure gastrointestinal bleeding (OGIB) who underwent both CE and double-balloon endoscopy at our institution, we enrolled 64 patients with small-bowel angioectasia (angioectasia group) and 97 patients without small-bowel angioectasia (non-angioectasia group). The angioectasia group was subdivided into patients with type 1a angioectasia (35 cases) and type 1b angioectasia (29 cases) according to the Yano-Yamamoto classification. Patient characteristics, treatment, and outcomes were evaluated.ResultsAge (P = 0.001), cardiovascular disease (P = 0.002), and liver cirrhosis (P = 0.003) were identified as significant predictors of small-bowel angioectasia. Multivariate logistic regression analysis identified cardiovascular disease (odds ratio 2.86; 95 % confidence interval, 1.35–6.18) and liver cirrhosis (odds ratio 4.81; 95 % confidence interval, 1.79–14.5) as independent predictors of small-bowel angioectasia. Eleven type 1a cases without oozing were treated conservatively, and 24 type 1a cases with oozing were treated with polidocanol injection (PDI). Re-bleeding occurred in two type 1a cases (6 %). Seventeen type 1b cases were treated with PDI and 12 type 1b cases were treated with PDI combined with argon plasma coagulation (APC) or clipping. Re-bleeding occurred in five type 1b cases (17 %) that resolved after additional endoscopic hemostasis in all cases. There was one adverse event from endoscopic treatment (1.6 %).ConclusionsCardiovascular disease and liver cirrhosis were significant independent major predictors of small-bowel angioectasia. Type 1a angioectasias with oozing are indicated for PDI and type 1b angioectasias are indicated for PDI with APC or clipping.
Highlights
Small-bowel angioectasias are frequently diagnosed with capsule endoscopy (CE) or balloon endoscopy major predictors have not been defined and the indications for endoscopic treatment have not been standardized
Re-bleeding occurred in five cases (17 %), four who had been initially treated with polidocanol injection (PDI), and one who had been initially treated with PDI combined with argon plasma coagulation (APC) (Table 4)
The Kaplan-Meier curve for post-treatment re-bleeding in type 1b angioectasias showed no statistically significant difference between those treated with PDI alone and those treated with PDI combined with APC or clipping (P = 0.29) (Fig. 3)
Summary
Small-bowel angioectasias are frequently diagnosed with capsule endoscopy (CE) or balloon endoscopy major predictors have not been defined and the indications for endoscopic treatment have not been standardized. Small-bowel angioectasias comprise the majority of small-bowel vascular lesions and are found in 30–40 % of OGIB cases [6]. Yano-Yamamoto’s [7] accepted endoscopic classification of small-bowel vascular lesions classifies small-bowel angioectasia as a type 1 lesion (Fig. 1). These lesions are further subclassified, as follows: type 1a lesions are characterized by punctate erythema (
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