Obscure Gastrointestinal Hemorrhage from Mesenteric Varices Diagnosed by Video Capsule Endoscopy

Fix, Oren K.; Simon, Jonathan T.; Farraye, Francis A.; Oviedo, Jaime A.; Pratt, Daniel S.; Chen, William T.; Cave, David R.

doi:10.1007/s10620-006-8027-6

Cited by 10 publications

(7 citation statements)

References 23 publications

(72 reference statements)

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“…The identification of portal hypertensive enteropathy is potentially important because gastrointestinal bleeding secondary to this condition is associated with high mortality [24] . In previous studies in cirrhotic patients, the prevalence of portal hypertensive enteropathy in CE varied between 63 and 68%, which is similar to our findings (77.8%) [25][26][27] .…”

Section: Discussionmentioning

confidence: 99%

Can Capsule Endoscopy Be Used as a Diagnostic Tool in the Evaluation of Nonbleeding Indications in Daily Clinical Practice? A Prospective Study

et al. 2011

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Objective: To evaluate the diagnostic yield of capsule endoscopy (CE) and its impact on treatment and outcome in patients without bleeding indications. Subjects and Methods: One hundred and sixty-five nonbleeding patients were enrolled in the study. The most common indications for CE were chronic abdominal pain alone (33 patients) or combined with chronic diarrhea (31 patients) and chronic diarrhea alone (30 patients). Among the 165 patients, 129 underwent CE for evaluation of gastrointestinal symptoms and 36 for surveillance or disease staging. Results: CE findings were positive, suspicious and negative in 73 (44.2%), 13 (7.9%) and 79 (47.9%) of cases, respectively. The diagnostic yield was highest in patients with refractory celiac disease (10/10, 100%) and suspected Crohn’s disease (5/6, 83.3%), followed by patients with chronic abdominal pain and chronic diarrhea (13/31, 41.9%), established Crohn’s disease (2/6, 33.3%), chronic diarrhea alone (8/30, 26.7%), chronic abdominal pain alone (8/33, 24.2%) and other indications (3/13, 23.1%) (p < 0.005). The CE findings led to a change of medication in 74 (47.7%) patients, surgery in 15 (9.7%), administration of a strict gluten-free or other special diet in 13 (8.4%) and had other consequences in 11 (6.7%). Management was not modified in 42 (27.1%) patients. Among symptomatic patients (n = 129), 29 (22.5%) were lost to follow-up. The remaining 100 patients were followed up for 8.7 ± 4.0 months (range 2–19). Among the latter, resolution or improvement of symptoms was observed in 86 (86%) patients, no change in 11 (11%) and 3 (3%) died. All 86 patients who experienced resolution or improvement of their symptoms had a modification of their management after CE; only 7/11 patients whose symptoms did not change (63.6%) and 2/3 patients who died (66.7%) had a modification of management (p < 0.001). Conclusions: CE appears to be a useful tool in the evaluation of patients with nonbleeding indications. The outcome of most patients with negative findings was excellent.

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Section: Discussionmentioning

confidence: 99%

Can Capsule Endoscopy Be Used as a Diagnostic Tool in the Evaluation of Nonbleeding Indications in Daily Clinical Practice? A Prospective Study

et al. 2011

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“…Th ose with refractory bleeding, defi ned as patients requiring >5 U of blood within 3 months aft er conventional treatment, were given depot octreotide LAR intramuscularly monthly or Lanreotide 90 mg monthly for a mean of 12 months (range 6-36 months). Transfusion requirements during treatment decreased to 2 (range 0-14) vs. 10 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) in the period before treatment ( P <0.001). Th e number of patients experiencing a bleeding episode also decreased to 20% in the treatment group compared with 73% in the pretreatment phase ( p =0.001).…”

Section: Surgical Treatmentmentioning

confidence: 98%

“…CTE could be considered before VCE in the setting of established infl ammatory bowel disease, prior radiation therapy, previously small bowel surgery, and/or suspected small bowel stenosis (strong recommendation, very low level of evidence). 15. In patients with suspected small bowel bleeding and negative VCE examination, CTE should be performed if there is high clinical suspicion for a small bowel source despite performance of a prior standard CT of the abdomen (conditional recommendation, very low level of evidence).…”

Section: Usage Of Radiographic Examinationsmentioning

confidence: 99%

“…Patients with disorders associated with portal hypertension and/or with endoscopic evidence of varices or portal hypertension have also demonstrated portal hypertensive changes in the small bowel on VCE or enteroscopy studies ( 15 ). Other rare causes of bleeding from the small bowel have included Kaposi's sarcoma associated with acquired immunodefi ciency syndrome, Plummer-Vinson syndrome, pseudoxanthoma elasticum, Ehlers-Danlos syndrome, Henoch-Schoenlein purpura, neurofi bromatosis, malignant atrophic papulosis, and other inherited polyposis syndromes.…”

Section: Rare Causes and Non-small Bowel Sources Of Bleedingmentioning

confidence: 99%

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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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“…La vidéocapsule est une méthode non invasive qui permet de visualiser les varices grêliques et duodénales, mais souvent sans pouvoir en préciser la localisation précise. Fix et al [3] ont rapporté trois cas d'hémorragie digestive inexpliquée qui ont pu être attribué à la rupture de varices mésentériques grêliques grâce à la vidéocapsule grêlique. Dans l'étude de De Palma et al [4], la vidéocapsule a permis de diagnostiquer des varices L'entéroscopie double ballon a un double intérêt : diagnostique, avec une sensibilité globale de 80 %, s'inscrivant dans la recherche d'hémorragie digestive avec une sensibilité de 65,9 %, de lésion tumorale ou de syndrome de malabsorption ; mais aussi thérapeutique dans 41,5 % des cas (électrocoagulation au laser argon, polypectomie, dilatation de sténose) avec la possibilité de réaliser plusieurs séances thérapeutiques en cas de récidive hémorragique [5,6].…”

Section: Discussionunclassified

Hémostase endoscopique par entéroscopie double ballon de varices anastomotiques cholédocojéjunales

Gomercic¹,

Vanbiervliet²,

Rakotoarisoa³

et al. 2011

Acta Endosc

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L'hémorragie digestive par rupture de varices ectopiques est une complication rare de l'hypertension portale (HTP). La rareté de cette situation d'urgence explique le manque de consensus concernant sa prise en charge. Le traitement peut être médical, radiologique, chirurgical ou endoscopique. L'endoscopie dans ce cas peut être techniquement rendue difficile pour des raisons d'accessibilité comme dans le cas de varices grêliques. Nous vous présentons le cas d'une patiente ayant des varices anastomotiques cholédo-cojéjunales hémorragiques traitées efficacement par encollage grâce à l'entéroscopie à double ballon. Pour citer cette revue : Acta Endosc. 41 (2011). Mots clés Entéroscopie double ballon · Varice ectopique · Anastomose cholédocojéjunale · Hypertension portaleAbstract Gastrointestinal bleeding secondary to rupture from ectopic varices is an infrequent complication due to portal hypertension. The unusual happening of this emergency situation explains the lack of consensus regarding its management. The treatment may be medical, radiological, surgical or endoscopic. The endoscopy in this case can be technically difficult for accessibility reasons, as in the case of small-bowel varices. We present the case of a patient with bleeding varices from choledoco-jejunal anastomosis treated effectively by sclerotherapy with double balloon enteroscopy. To cite this journal: Acta Endosc. 41 (2011).

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Obscure Gastrointestinal Hemorrhage from Mesenteric Varices Diagnosed by Video Capsule Endoscopy

Cited by 10 publications

References 23 publications

Can Capsule Endoscopy Be Used as a Diagnostic Tool in the Evaluation of Nonbleeding Indications in Daily Clinical Practice? A Prospective Study

Can Capsule Endoscopy Be Used as a Diagnostic Tool in the Evaluation of Nonbleeding Indications in Daily Clinical Practice? A Prospective Study

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding

Hémostase endoscopique par entéroscopie double ballon de varices anastomotiques cholédocojéjunales

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