Major predictors and management of small-bowel angioectasia

BMC Gastroenterology

Research Article

Shinji Tanaka¹  Shiro Oka¹  Kazuaki Chayama²  Taiki Aoyama²  Sayoko Kunihara²  Atsushi Igawa²  Makoto Nakano² 

[1] Department of Endoscopy, Hiroshima University, 1-2-3 Kasumi, 734-8551, Minami-ku, Hiroshima, Japan;Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan;

关键词: Endoscopic Treatment;    Capsule Endoscopy;    Argon Plasma Coagulation;    Polidocanol;    Endoscopic Hemostasis;   

DOI  :  10.1186/s12876-015-0337-8

 received in 2015-04-07, accepted in 2015-08-13,  发布年份 2015

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Igawa et al. 2015