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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

Kaplan-Meier curve for post treatment re-bleeding according to treatment for patients with type 1b angioectasia. PDI, polidocanol injection; APC, argon plasma coagulation
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Fig3: Kaplan-Meier curve for post treatment re-bleeding according to treatment for patients with type 1b angioectasia. PDI, polidocanol injection; APC, argon plasma coagulation

Mentions: Eleven type 1a cases without oozing were treated conservatively without endoscopic intervention, and 24 type 1a cases with oozing were treated endoscopically with PDI. Re-bleeding occurred in two cases (6 %), one was treated conservatively and the other was treated with PDI. The mean time to re-bleeding was 23 days, and in both cases, bleeding occurred from lesions other than those previously treated. One patient had bleeding from a small-bowel arteriovenous malformation and the other had a small-bowel Dieulafoy’s lesion. Of the type 1b cases, 17 were treated with PDI and 12 were treated with PDI combined with APC or clipping. Re-bleeding occurred in five cases (17 %), four who had been initially treated with PDI, and one who had been initially treated with PDI combined with APC (Table 4). The mean time to re-bleeding was 123 days. Four re-bleeding cases involved previously treated lesions, and one involved a previously untreated lesion. Re-bleeding was controlled conservatively with additional endoscopic hemostasis in all cases. 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). One adverse event (1.6 %) occurred as a result of endoscopic treatment in a patient who developed an ulcer after PDI. This patient recovered with conservative treatment.Table 4


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)

Kaplan-Meier curve for post treatment re-bleeding according to treatment for patients with type 1b angioectasia. PDI, polidocanol injection; APC, argon plasma coagulation
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Kaplan-Meier curve for post treatment re-bleeding according to treatment for patients with type 1b angioectasia. PDI, polidocanol injection; APC, argon plasma coagulation
Mentions: Eleven type 1a cases without oozing were treated conservatively without endoscopic intervention, and 24 type 1a cases with oozing were treated endoscopically with PDI. Re-bleeding occurred in two cases (6 %), one was treated conservatively and the other was treated with PDI. The mean time to re-bleeding was 23 days, and in both cases, bleeding occurred from lesions other than those previously treated. One patient had bleeding from a small-bowel arteriovenous malformation and the other had a small-bowel Dieulafoy’s lesion. Of the type 1b cases, 17 were treated with PDI and 12 were treated with PDI combined with APC or clipping. Re-bleeding occurred in five cases (17 %), four who had been initially treated with PDI, and one who had been initially treated with PDI combined with APC (Table 4). The mean time to re-bleeding was 123 days. Four re-bleeding cases involved previously treated lesions, and one involved a previously untreated lesion. Re-bleeding was controlled conservatively with additional endoscopic hemostasis in all cases. 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). One adverse event (1.6 %) occurred as a result of endoscopic treatment in a patient who developed an ulcer after PDI. This patient recovered with conservative treatment.Table 4

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