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Frequency and risk factors for rebleeding events in patients with small bowel angioectasia.

Sakai E, Endo H, Taguri M, Kawamura H, Taniguchi L, Hata Y, Ezuka A, Nagase H, Kessoku T, Ishii K, Arimoto J, Yamada E, Ohkubo H, Higurashi T, Koide T, Nonaka T, Takahashi H, Nakajima A - BMC Gastroenterol (2014)

Bottom Line: The 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).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.Careful follow-up is needed for patients with multiple lesions, presence of which is considered as a significant risk factor for rebleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. eiji525@yokohama-cu.ac.jp.

ABSTRACT

Background: Small 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.

Methods: A 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.

Results: The 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.

Conclusion: In 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.

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Related in: MedlinePlus

Cumulative rebleeding rates according to the therapeutic choice. The risk of rebleeding tended to be lower in the patients who had undergone endoscopic treatment than in those who had not received endoscopic treatment, although the difference did not reach statistical significance (P = 0.14, log rank test).
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Fig3: Cumulative rebleeding rates according to the therapeutic choice. The risk of rebleeding tended to be lower in the patients who had undergone endoscopic treatment than in those who had not received endoscopic treatment, although the difference did not reach statistical significance (P = 0.14, log rank test).

Mentions: The overall rebleeding rate over a median follow-up duration of 30.5 months was 33.8% (23/68 cases) (interquartile range 16.5–47.0). In most cases, the first rebleeding episode occurred within 24 months after the CE, with a median time to rebleeding of 9.0 months (range 3.0–28.0). Although the rebleeding rate in the patients who had undergone endoscopic treatment was slightly lower than that in the patients who had not undergone endoscopic treatment, the difference did not reach statistical significance (22.7% vs. 39.1%, P = 0.27). As shown in Figure 3, 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, this difference also did not reach statistical significance (P = 0.14).Figure 3


Frequency and risk factors for rebleeding events in patients with small bowel angioectasia.

Sakai E, Endo H, Taguri M, Kawamura H, Taniguchi L, Hata Y, Ezuka A, Nagase H, Kessoku T, Ishii K, Arimoto J, Yamada E, Ohkubo H, Higurashi T, Koide T, Nonaka T, Takahashi H, Nakajima A - BMC Gastroenterol (2014)

Cumulative rebleeding rates according to the therapeutic choice. The risk of rebleeding tended to be lower in the patients who had undergone endoscopic treatment than in those who had not received endoscopic treatment, although the difference did not reach statistical significance (P = 0.14, log rank test).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4262995&req=5

Fig3: Cumulative rebleeding rates according to the therapeutic choice. The risk of rebleeding tended to be lower in the patients who had undergone endoscopic treatment than in those who had not received endoscopic treatment, although the difference did not reach statistical significance (P = 0.14, log rank test).
Mentions: The overall rebleeding rate over a median follow-up duration of 30.5 months was 33.8% (23/68 cases) (interquartile range 16.5–47.0). In most cases, the first rebleeding episode occurred within 24 months after the CE, with a median time to rebleeding of 9.0 months (range 3.0–28.0). Although the rebleeding rate in the patients who had undergone endoscopic treatment was slightly lower than that in the patients who had not undergone endoscopic treatment, the difference did not reach statistical significance (22.7% vs. 39.1%, P = 0.27). As shown in Figure 3, 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, this difference also did not reach statistical significance (P = 0.14).Figure 3

Bottom Line: The 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).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.Careful follow-up is needed for patients with multiple lesions, presence of which is considered as a significant risk factor for rebleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. eiji525@yokohama-cu.ac.jp.

ABSTRACT

Background: Small 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.

Methods: A 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.

Results: The 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.

Conclusion: In 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.

Show MeSH
Related in: MedlinePlus