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

Abstract

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.

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

“…In our study, the overall rebleeding rate was 22.7%, regardless of ET, which was lower than that reported in the systematic review. According to a recent Japanese study, although there was no statistically significant difference, the rebleeding rates in patients who had and had not undergone ET were 22.7% and 39.1%, respectively. This is comparable with our results.…”

Small Intestinal Angioectasias Are Not Randomly Distributed in the Small Bowel and Most May Be Reached by Push Enteroscopy

“…Having multiple lesions was the only independent predictor in their study of rebleeding. 14 Byeon et al 15 looked at the utility of repeat DBE in the same direction in patients with recurrent obscure GI bleeding. The vast majority of these patients had bleeding from angioectasia and most had oral approach DBE.…”

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

“…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…”