A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia

Junquera, Félix; Feu, Faust; Papo, Matthias; Videla, Sebastián; Armengol, J R; Bordas, Josep M.; Saperas, Esteban; Piqué, Josep M.; Malagelada, J.-R.

doi:10.1053/gast.2001.28650

Cited by 220 publications

(162 citation statements)

References 24 publications

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“…Hormone therapy has been abandoned with negative results from a randomized trial. 24 Outcome and cost-effectiveness of BE vs. other diagnostic and therapeutic modalities depends on pretest probability of small bowel bleeding and the probability of the expected findings that again depends on patient age and performance status.…”

Section: Treatment Of Small Bowel Bleedingmentioning

confidence: 99%

Interventional balloon-enteroscopy

Albert¹

2012

jig

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Section: Treatment Of Small Bowel Bleedingmentioning

confidence: 99%

Interventional balloon-enteroscopy

Albert¹

2012

jig

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“…For example, the cumulative incidences of overt rebleeding at 1 and 3 years were 26% and 45%, respectively, and the rates of occult rebleeding at 1 and 3 years were 46% and 64%, respectively. 8,9 A previous episode of rebleeding is an independent risk factor for further rebleeding. 10 Up to 12% of these patients require surgical treatment, 11 and the angiodysplasia related mortality rate is around 2%.…”

Section: Discussionmentioning

confidence: 99%

Success of Minimally Invasive Transumbilical Single-Incision Laparoscopic Surgery (T-SILS) Plus Double-Balloon Endoscopy (DBE) for Pediatric Intestinal Angiodysplasia: A Case Report

Mori

Koike

Inoue

et al. 2015

International Surgery

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We describe here a child with angiodysplasia of the small intestine, diagnosed by doubleballoon endoscopy (DBE), who was treated with transumbilical single-incision laparoscopic surgery (T-SILS). A 9-year-old boy presented to another hospital with intermittent fresh melena of a duration of 5 months and 4 days. Anoscopy and gastric mucosal membrane scintigraphy were unsuccessful diagnostically, and he was referred to our hospital for further examination and treatment. Under general anesthesia, we performed DBE by an anal route, with the ileum assessed for a distance of about 150 cm from the ileocecal valve. Although no bleeding lesion was found in the colon, a flat elevated venous lake approximately 20 mm in size was observed 20 cm from the ileocecal valve, suggesting angiodysplasia of the small intestine. A tattoo was made under DBE, and wedge resection by T-SILS was performed 1 month later under general anesthesia. The excised specimen appeared as a flat, elevated venous lake approximately 20 mm in size. Histopathologic analysis revealed several dilated and distorted veins within the submucosa of the small intestine. The patient was diagnosed with angiodysplasia of the small intestine. His postoperative course was uneventful, and he remained free of recurrent gastrointestinal bleeding 18 months after the operation. This is the first case report showing the diagnosis, localization, and tattooing of an obscure gastrointestinal bleeding lesion of the small intestine by preoperative DBE and removal of the lesion by subsequent T-SILS in children.

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“…In the first study, patients with out-of-reach bleeding small-bowel angiodysplasias were treated using high-dose estrogens, estrogen-progesterone or placebo, but no statistical improvement of transfusion requirements was observed amongst the groups. 5 Additionally, in the second study, the authors failed to identify any significant effect of hormonal therapy compared to placebo in 72 non-cirrhotic patients bleeding from documented angiodysplasia 6 . This latter study, however, has setbacks such as the use of low doses of ethynil estradiol and the exclusion of patients with vascular ectasia associated to cirrhosis and HHT.…”

Section: Hormonal Therapymentioning

confidence: 99%