Clinical outcome after enteroscopy for small bowel angioectasia bleeding: A Korean Associateion for the Study of Intestinal Disease (KASID) multiceter study

Jeon, Seong Ran; Byeon, Jeong‐Sik; Jang, Hyun Joo; Park, Soo Jung; Im, Jong Pil; Kim, Eun Ran; Koo, Ja Seol; Ko, Bong Min; Chang, Dong Kyung; Kim, Jin–Oh; Park, Suyeon

doi:10.1111/jgh.13479

Cited by 21 publications

(10 citation statements)

References 29 publications

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“…of AD pts analyzedNo. of pts with rebleedsType/detection of ADFollow-up: % and yearsOutcomeOutcomesSignificant risk factors multivariate analysisEffect OR/HR (95%-CI)Mai et al USA, 2017 [43]RC8714SBA, capsule endoscopy100% at least 1 yearRebleedsNon-isolated GIAD4.2 (1.1–16.2)Chronic kidney disease4.5 (1.0–19.6)Congestive heart failure4.5 (1.0–19.9)90-day mortalityInpatients17.7 (1.7–185.1)Kaufman et al USA, 2016 [44]RC15646SBA, capsule endoscopy–RebleedsAge of diagnosis1.05 (1.01–1.09)Active bleeding on capsule endoscopy2.69 (1.15–6.30)Location: quartile 34.29 (1.46–12.56)Jeon et al Korea, 2016 [45]RC6615Balloon assisted enteroscopy90%, mean 1.8RebleedsLiver cirrhosis4.01 (1.1–15.0)Holleran et al Ireland, 2016 [46]RC5645SBA, capsule endoscopy65%, mean 2.7RebleedsMultiple lesions–Valvular heart disease–Sakai et al Japan, 2014 [47]RC6823Capsule endoscopy92%, median 2.5Rebleeds…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2019

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“…Argon plasma coagulation can therefore result in an initial improvement in Hb but it does not contribute to a sustained maintenance of Hb. In addition, whilst many studies discuss rebleeding rate, detailed information on Hb measurements post endotherapy are not always provided [27,34,35].…”

Section: Discussionmentioning

confidence: 99%

Refractory Anaemia Secondary to Small Bowel Angioectasias - Comparison between Endotherapy Alone versus Combination with Somatostatin Analogues

Zammit

Sidhu

Sanders

2017

JGLD

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Background & Aims: Patients with small bowel angioectasias (SBAs) can be difficult to manage as they are generally elderly with multiple co-morbidities. Angioectasias are multiple and tend to recur. Argon plasma coagulation (APC), despite being a commonly used method to treat these patients has an associated persistent rate of re-bleeding necessitating additional treatment to manage these patients.Methods: All patients with refractory iron deficiency anaemia secondary to SBAs were retrospectively subdivided into two groups. Patients in group 1 were managed with double balloon enteroscopy (DBE) and APC alone and those in group 2 received Lanreotide in addition to DBE and APC.Results: A total of 49 patients were included in this study: group 1: 37 patients (75.5%), group 2: 12 patients (24.5%). All had significant comorbidities and the mean duration of anaemia was 114.3, SD 307.0 months. Significant improvements in haemoglobin (Hb) (11g/L vs 3.2g/L p=0.043), transfusion requirements per month (0.8 vs 4.7 p=0.052) and mean bleeding episodes (1.08 vs 2.6 p=0.032) were demonstrated in group 2 when compared to group 1. One patient developed symptomatic gallstone disease and one patient stopped Lanreotide due to a lack of response.Conclusions: This is the first study comparing endotherapy to a combination of endotherapy and pharmacotherapy. It shows a significantly better outcome in patients receiving a combination of endotherapy and Lanreotide. Lanreotide can be a safe additional treatment in patients not responding to APC alone.Abbreviations: APC: argon plasma coagulation; CE: capsule endoscopy; DBE double balloon enteroscopy; Hb: hemoglobin; OGIB: over gastrointestinal bleeding; SBAs: small bowel angioectasias.

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“…Moreover, most cohorts don't divide their therapeutic results between patients with overt and occult-OGIB/IDA. However, several retrospective and prospective observational studies reported a high therapeutic yield -usually defined as the ability to successfully perform therapeutic endoscopic procedures or improvement in hemoglobin levels/decrease in transfusion requirements [19,20,39,[50][51][52][53][54][55]. In spite of achieving a high endoscopic therapeutic success and a reduction in the need for transfusion support, two systematic reviews concluded that the rate of recurrence/rebleeding is substantial [56,57].…”

Section: Small Bowel Bleedingmentioning

confidence: 99%

Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups

Pérez-Cuadrado-Robles

Pinho

González

et al. 2020

GE Port J Gastroenterol

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The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.

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Clinical outcome after enteroscopy for small bowel angioectasia bleeding: A Korean Associateion for the Study of Intestinal Disease (KASID) multiceter study

Cited by 21 publications

References 29 publications

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

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

Refractory Anaemia Secondary to Small Bowel Angioectasias - Comparison between Endotherapy Alone versus Combination with Somatostatin Analogues

Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups

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