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Major predictors and management of small-bowel angioectasia.

Igawa A, Oka S, Tanaka S, Kunihara S, Nakano M, Aoyama T, Chayama K - BMC Gastroenterol (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. igawa@hiroshima-u.ac.jp.

ABSTRACT

Background: Small-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.

Methods: Among 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.

Results: Age (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%).

Conclusions: Cardiovascular 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.

No MeSH data available.


Related in: MedlinePlus

Flow chart of study patients. * Obscure gastrointestinal bleeding ** Capsule endoscopy *** Double-balloon endoscopy
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Fig2: Flow chart of study patients. * Obscure gastrointestinal bleeding ** Capsule endoscopy *** Double-balloon endoscopy

Mentions: A total of 800 patients with OGIB presented to Hiroshima University Hospital between April 2004 and December 2013. Two hundred thirty-eight of those patients underwent both CE and DBE. Sixty-four patients diagnosed with small-bowel angioectasia were assigned to the angioectasia group. Ninety-seven patients without small-bowel angioectasia were assigned to the non-angioectasia group. We excluded 77 patients in whom the entire small bowel had not been visualized. The angioectasia group was subclassified into patients with type 1a (35 cases) and type 1b (29 cases) angioectasias according to the Yano-Yamamoto classification (Fig. 2). All patients underwent upper and lower gastrointestinal endoscopies prior to CE and DBE.Fig. 2


Major predictors and management of small-bowel angioectasia.

Igawa A, Oka S, Tanaka S, Kunihara S, Nakano M, Aoyama T, Chayama K - BMC Gastroenterol (2015)

Flow chart of study patients. * Obscure gastrointestinal bleeding ** Capsule endoscopy *** Double-balloon endoscopy
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4549087&req=5

Fig2: Flow chart of study patients. * Obscure gastrointestinal bleeding ** Capsule endoscopy *** Double-balloon endoscopy
Mentions: A total of 800 patients with OGIB presented to Hiroshima University Hospital between April 2004 and December 2013. Two hundred thirty-eight of those patients underwent both CE and DBE. Sixty-four patients diagnosed with small-bowel angioectasia were assigned to the angioectasia group. Ninety-seven patients without small-bowel angioectasia were assigned to the non-angioectasia group. We excluded 77 patients in whom the entire small bowel had not been visualized. The angioectasia group was subclassified into patients with type 1a (35 cases) and type 1b (29 cases) angioectasias according to the Yano-Yamamoto classification (Fig. 2). All patients underwent upper and lower gastrointestinal endoscopies prior to CE and DBE.Fig. 2

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. igawa@hiroshima-u.ac.jp.

ABSTRACT

Background: Small-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.

Methods: Among 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.

Results: Age (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%).

Conclusions: Cardiovascular 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.

No MeSH data available.


Related in: MedlinePlus