A Risk Assessment of Factors for the Presence of Angiodysplasias During Endoscopy and Factors Contributing to Symptomatic Bleeding and Rebleeds

Abstract

BackgroundFew studies have assessed factors associated with angiodysplasias during endoscopy or factors associated with symptomatic disease.AimsTo evaluate risk factors for the presence of and contribution to symptomatic disease in patients with angiodysplasias.MethodsWe performed a systematic MEDLINE, EMBASE and Cochrane Library search according to the PRISMA guidelines for studies assessing risk factors involved in angiodysplasias detected during endoscopy and factors that lead to anemia or overt bleeding. Study quality was assessed with the Newcastle–Ottawa scale. A risk assessment was performed by selecting risk factors identified by two independent studies and/or by a large effect size.ResultsTwenty-three studies involving 92,634 participants were included. The overall quality of the evidence was moderate. Risk factors for the diagnosis of angiodysplasias during endoscopy confirmed by at least two studies were increasing age (OR 1.09 per year, 95% CI 1.04–1.1), chronic kidney disease (OR 4.5, 95% CI 1.9–10.5) and cardiovascular disease (2.9, 95% CI 1.4–6.2). The risk of rebleeds was higher in the presence of multiple lesions (OR 4.2, 95% CI 1.1–16.2 and 3.8, 95% CI 1.3–11.3 and 8.6, 95% CI 1.4–52.6), liver cirrhosis (OR 4.0, 95% 1.1–15.0) and prothrombin time < 30% (OR 4.2, 95% 1.1–15.4) with a moderate effect size. Multiple comorbidities were associated with an increased in-hospital mortality (OR 2.29, 95% CI 1.2–4.3).ConclusionsThis systematic review identified age, chronic kidney disease and cardiovascular disease as the most important risk factors for the diagnosis of angiodysplasias during endoscopy. Multiple lesions increase the risk of recurrent bleeding.Electronic supplementary materialThe online version of this article (10.1007/s10620-019-05683-7) contains supplementary material, which is available to authorized users.

Scoring systems in clinical small-bowel capsule endoscopy: all you need to know!

“…Many other clinical variables have been associated with an increased risk of rebleeding, such as overt bleeding 55 , low hemoglobin level with higher transfusion requirements 56 57 , CE positive findings 58 59 , ≥ 3 angiectasias 60 61 , lesion size 62 , proximal location in the SB 63 64 , Yano-Yamamoto classification 25 , chronic renal disease 65 66 , cirrhosis 43 , cardiac disease 21 60 , antiplatelet or nonsteroidal anti-inflammatory drug (NSAID) use 47 , among others. Besides the aforementioned Ohmiya score, other scoring systems with clinical applicability have been recently devised for this purpose, integrating and weighting many of the described potential predictive factors to give a magnitude of the risk of rebleeding for each individual patient, allowing physicians to objectively stratify the risk and tailor the follow-up strategy accordingly.…”

Evaluation and Validation of a New Score to Measure the Severity of Small Bowel Angiodysplasia on Video Capsule Endoscopy

“…OGIB is the most frequent indication for VCE, which reveals the presence of AD in 50–60% as the cause of bleeding [17-19]. SBAD manifest clinically as recurrent episodes of anemia associated with occult or visible bleeding [10, 11, 20-22]. In a study involving 56 patients with SBAD, bleeding recurrence occurred in 80% of the cases.…”

“…In 2–3% of the cases, they can be the cause of death, particularly in elderly subjects with cardiovascular disease or kidney failure [9]. Bleeding recurrence of SBAD is frequent, so patients require repeated treatments and hospital readmissions, which significantly affect quality of life [10, 11].…”

Artificial intelligence and capsule endoscopy: automatic detection of vascular lesions using a convolutional neural network

“…Angiectasia is the most commonly found lesion with high bleeding potential among patients undergoing CE for OGIB [ 5 ]. These lesions are associated with chronic blood loss and are most commonly found in the elderly, patients with chronic kidney disease, cardiovascular disease and cirrhosis [ 8 , 9 ]. Other vascular lesions include enteric varices and red spots, which may be found in portal hypertension or diseases with systemic involvement [ 10 - 12 ].…”