Long-Term Outcome of Patients Treated With Double Balloon Enteroscopy for Small Bowel Vascular Lesions

Samaha, Elia; Rahmi, Gabriel; Landi, Bruno; Lorenceau-Savale, C; Malamut, Georgia; Jm, Canard; Bloch, Florian; Jian, Raymond; Châtellier, Gilles; Cellier, Christophe

doi:10.1038/ajg.2011.325

Cited by 107 publications

(67 citation statements)

References 19 publications

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“…As vascular endothelial growth factor (VEGF) accumulation has been demonstrated to be the most single common path- Samaha et al 52 May et al 53 Godeschalk et al 54 Shinozaki et al 55 Saperas et al 55 Gerson et al 14 Olmos et al 56 Olmos et al 57 Hayat et al 58 Schmit et al 59 Gupta et al 60 Lanthier et al 61 Rutgeerts et al 62 Lower limit …”

Section: Antiangiogenicsmentioning

confidence: 97%

Management of Gastrointestinal Angiodysplastic Lesions (GIADs): A Systematic Review and Meta-Analysis

Jackson¹,

Gerson

2014

American Journal of Gastroenterology

149

113

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Section: Antiangiogenicsmentioning

confidence: 97%

Management of Gastrointestinal Angiodysplastic Lesions (GIADs): A Systematic Review and Meta-Analysis

Jackson¹,

Gerson

2014

American Journal of Gastroenterology

149

113

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“…Of 261 patients who presented with suspected small bowel bleeding, 129 of 133 (97%) patients with small bowel vascular lesions were successfully treated with argon plasma coagulation (using DBE). At 36 months, rebleeding occurred in 45/98 (46%) patients ( 201 ). A second study involved 274 patients who had undergone DBE at two diff erent centers between 2004 and 2006 ( 14 ).…”

Section: Endoscopic Therapymentioning

confidence: 98%

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Gerson

Fidler

Cave³

et al. 2015

American Journal of Gastroenterology

562

559

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Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

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“…Angiodysplasia often has a multifocal pattern, elusive natural course and carries a high potential for rebleeding since half of the cases re-bled within 3 years despite ongoing usage of effective treatment modalities i.e. argon plasma coagulation (2,43). Consequently, re-bleeding risk seems to be directly linked to the underlying cause rather than VCE exam results or therapeutic treatment application.…”

Section: Re-bleeding Rate After Index Vce Small Bowel Examinationmentioning

confidence: 99%

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

et al. 2017

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Obscure gastrointestinal bleeding (OGIB) accounts for approximately 5% of all gastrointestinal (GI) hemorrhages. It usually arises from a small bowel lesion beyond the reach of conventional endoscopy including esophagogastroduodenoscopy and colonoscopy. Video capsule endoscopy (VCE) revolutionized the evaluation of OGIB patients since it allows reliable and noninvasive visualization of the small bowel mucosal surface. Since 2001, VCE has evolved into an efficient technology integrated in clinical practice. It is the cornerstone in the algorithm of OGIB investigation given its high diagnostic yield, which compares favorably to that of double-balloon enteroscopy (DBE). In terms of outcomes, a positive index VCE examination usually correlates to a high re-bleeding rate, while a negative one provides adequate evidence of low re-bleeding risk, suggesting a wait and watch approach in this subset of patients. Additionally, a variety of factors has been acknowledged as significant predictors of re-bleeding episodes. While research data regarding immediate endoscopic findings have matured, data concerning the clinical utility of VCE in patients with OGIB on the long-term remain sparse. This manuscript reviews the current literature, aiming to highlight the role of VCE in the long-term management of OGIB.

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Long-Term Outcome of Patients Treated With Double Balloon Enteroscopy for Small Bowel Vascular Lesions

Abstract: Endoscopic therapy using DBE for SBVL in patients with recurrent OGIB allows a long-term remission in more than half of the patients. Independent rebleeding risk factors after a first endoscopic therapy are an increased number of SBVL and an associated valvular/arrhythmic heart disease.

Cited by 107 publications

References 19 publications

Management of Gastrointestinal Angiodysplastic Lesions (GIADs): A Systematic Review and Meta-Analysis

Management of Gastrointestinal Angiodysplastic Lesions (GIADs): A Systematic Review and Meta-Analysis

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

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