Angiodysplasia of the lower gastrointestinal tract

Gupta, Navyash; Longo, Walter E.; Vernava, Anthony M.

doi:10.1007/bf02049736

Cited by 64 publications

(7 citation statements)

References 13 publications

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“…In the present study, while the first rebleeding episode occurred after 1 year in approximately 50% of the cases, in the majority of cases, rebleeding occurred within 2 years, suggesting that patients with small bowel angioectasia, especially those with multiple lesions, should be closely followed up for at least 2 years after the initial treatment. Although our results suggested that rebleeding could be controlled by repeat endoscopic treatment and iron replacement therapy in the majority of patients with small bowel angioectasia, some patients may be unsuitable for endoscopic treatment, as angioectasia is frequently detected in patients older than 60 years of age [ 32 ] and is often accompanied by severe comorbidities such as chronic renal failure [ 40 ] and cardiac valvular disease [ 41 ]. Pharmacological treatments such as thalidomide and octoreotide might serve as attractive options for these patients [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Frequency and risk factors for rebleeding events in patients with small bowel angioectasia

et al. 2014

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BackgroundSmall bowel angioectasia is reported as the most common cause of bleeding in patients with obscure gastrointestinal bleeding. Although the safety and efficacy of endoscopic treatment have been demonstrated, rebleeding rates are relatively high. To establish therapeutic and follow-up guidelines, we investigated the long-term outcomes and clinical predictors of rebleeding in patients with small bowel angioectasia.MethodsA total of 68 patients were retrospectively included in this study. All the patients had undergone CE examination, and subsequent control of bleeding, where needed, was accomplished by endoscopic argon plasma coagulation. Based on the follow-up data, the rebleeding rate was compared between patients who had/had not undergone endoscopic treatment. Multivariate analysis was performed using Cox proportional hazard regression model to identify the predictors of rebleeding. We defined the OGIB as controlled if there was no further overt bleeding within 6 months and the hemoglobin level had not fallen below 10 g/dl by the time of the final examination.ResultsThe overall rebleeding rate over a median follow-up duration of 30.5 months (interquartile range 16.5–47.0) was 33.8% (23/68 cases). The cumulative risk of rebleeding tended to be lower in the patients who had undergone endoscopic treatment than in those who had not undergone endoscopic treatment, however, the difference did not reach statistical significance (P = 0.14). In the majority of patients with rebleeding (18/23, 78.3%), the bleeding was controlled by the end of the follow-up period. Multiple regression analysis identified presence of multiple lesions (≥3) (OR 3.82; 95% CI 1.30–11.3, P = 0.02) as the only significant independent predictor of rebleeding.ConclusionIn most cases, bleeding can be controlled by repeated endoscopic treatment. Careful follow-up is needed for patients with multiple lesions, presence of which is considered as a significant risk factor for rebleeding.

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Section: Discussionmentioning

confidence: 99%

Frequency and risk factors for rebleeding events in patients with small bowel angioectasia

et al. 2014

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“…Aortic stenosis, 55 , 56 liver disease, CKD, 35 parasitism, 57 coagulopathies, 1 , 58 and Von Willebrand disease 59 are known risk factors for AGD in humans. Considering the small number of cases in dogs, it is not possible to yet determine risk factors for AGD among dogs.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal angiodysplasias diagnosed using video capsule endoscopy in 15 dogs

Defarges

Stiller

Solomon³

2023

Veterinary Internal Medicne

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Background Angiodysplasia (AGD) is rarely diagnosed in dogs with gastrointestinal bleeding (GIB) and is reported in case reports in dogs. Objective Describe signalment, clinical and diagnostic features of dogs with gastrointestinal (GI) AGD diagnosed by video capsule endoscopy (VCE). Animals Dogs with overt or suspected GIB which underwent VCE. Methods Dogs for which a VCE was submitted for overt or suspected GIB from 2016 to 2021 were selected retrospectively. Medical records and full‐length VCE recordings where AGDs were initially detected, were reviewed by 2 trained internists. AGD was considered definitive if 2 readers detected it. Signalment, clinical signs, blood work, medications, concurrent diseases, findings of previous conventional endoscopy, and surgical exploration (if applicable) of dogs with AGD were recorded. Results Definitive AGD was diagnosed in 15 of 291 (5%) dogs (12 males, 3 females). Twelve (80%) had overt GIB, 11 (73%) had hematochezia, and 6 (40%) had microcytic and hypochromic anemia. AGD was missed by conventional endoscopy in 9/9 dogs and exploratory surgery in 3/3 dogs. Thirteen capsules were administered by mouth (1 incomplete study), and 2 via endoscopy directly into the duodenum. AGD was visualized in the stomach of 3 dogs, in the small intestine of 4, and in the colon of 13 dogs. Conclusion and Clinical Importance Although rare, AGD should be considered in dogs with suspected GIB after a negative conventional endoscopy or surgical exporation. Video capsuel endoscopy appears to be a sensitive test to identify AGD within the GI tract.

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“…Angioectasia is of the vascular type, with dilated capillaries in the lamina propria and submucosa, and it accounts for 23-52% of hemorrhagic lesions [3,9,[19][20][21]. Small bowel angioectasia is an acquired disease often seen in patients with valvular heart disease, diabetes, or renal disease [22,23]. These patients often receive antithrombotic therapy for underlying conditions, which leads to overt bleeding requiring treatment in some cases, although not a few patients are asymptomatic without bleeding [21].…”

Section: Discussionmentioning

confidence: 99%

Contribution of Capsule Endoscopy Early in a Bleeding Episode to Treatment of Small Bowel Angioectasia: A Case Report

et al. 2021

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Background: Recent advances in endoscopic devices such as small bowel capsule endoscopy and balloon-assisted endoscopy have improved the level of medical care for small bowel bleeding. However, treating small bowel angioectasia remains challenging because repeated intermittent bleeding can occur from the multiple minute lesions (about 1 mm in size) that develop in a synchronous and metachronous manner. Here, we report a case of small bowel angioectasia in which capsule endoscopy performed early in a bleeding episode contributed to treatment. Case Summary: A 66-year-old man with suspected small bowel bleeding underwent small bowel capsule endoscopy and balloon-assisted endoscopy with argon plasma coagulation hemostasis for a small intestinal angioectasia. Because small bowel bleeding recurred intermittently after the treatment, small bowel capsule endoscopy and balloon-assisted endoscopy were repeated when there was no bleeding, but no abnormalities were found. Subsequent small bowel capsule endoscopy during a bleeding episode revealed bloody intestinal fluid in the proximal small intestine. Peroral balloon-assisted endoscopy was performed 2 days after SBCE for detailed observation of the small intestinal mucosa at the suspected bleeding site, and there a 1-mm Dieulafoy’s lesion with no active bleeding was identified. We performed argon plasma coagulation, and no bleeding was observed thereafter. Conclusions: Small bowel capsule endoscopy immediately after bleeding onset can identify the bleeding source of multiple minute lesions in small bowel angioectasia.

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Angiodysplasia of the lower gastrointestinal tract

Cited by 64 publications

References 13 publications

Frequency and risk factors for rebleeding events in patients with small bowel angioectasia

Frequency and risk factors for rebleeding events in patients with small bowel angioectasia

Gastrointestinal angiodysplasias diagnosed using video capsule endoscopy in 15 dogs

Contribution of Capsule Endoscopy Early in a Bleeding Episode to Treatment of Small Bowel Angioectasia: A Case Report

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