Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Gastroenterology
Published in: BMC Gastroenterology 1/2015

Open Access 01-12-2015 | Research article

Major predictors and management of small-bowel angioectasia

Authors: Atsushi Igawa, Shiro Oka, Shinji Tanaka, Sayoko Kunihara, Makoto Nakano, Taiki Aoyama, Kazuaki Chayama

Published in: BMC Gastroenterology | Issue 1/2015

Login to get access

Abstract

Background

Small-bowel angioectasias are frequently diagnosed with capsule endoscopy (CE) or balloon endoscopy however, major predictors have not been defined and the indications for endoscopic treatment have not been standardized. The aim of this study was to evaluate the predictors and management of small-bowel angioectasia.

Methods

Among patients with obscure gastrointestinal bleeding (OGIB) who underwent both CE and double-balloon endoscopy at our institution, we enrolled 64 patients with small-bowel angioectasia (angioectasia group) and 97 patients without small-bowel angioectasia (non-angioectasia group). The angioectasia group was subdivided into patients with type 1a angioectasia (35 cases) and type 1b angioectasia (29 cases) according to the Yano-Yamamoto classification. Patient characteristics, treatment, and outcomes were evaluated.

Results

Age (P = 0.001), cardiovascular disease (P = 0.002), and liver cirrhosis (P = 0.003) were identified as significant predictors of small-bowel angioectasia. Multivariate logistic regression analysis identified cardiovascular disease (odds ratio 2.86; 95 % confidence interval, 1.35–6.18) and liver cirrhosis (odds ratio 4.81; 95 % confidence interval, 1.79–14.5) as independent predictors of small-bowel angioectasia. Eleven type 1a cases without oozing were treated conservatively, and 24 type 1a cases with oozing were treated with polidocanol injection (PDI). Re-bleeding occurred in two type 1a cases (6 %). Seventeen type 1b cases were treated with PDI and 12 type 1b cases were treated with PDI combined with argon plasma coagulation (APC) or clipping. Re-bleeding occurred in five type 1b cases (17 %) that resolved after additional endoscopic hemostasis in all cases. There was one adverse event from endoscopic treatment (1.6 %).

Conclusions

Cardiovascular disease and liver cirrhosis were significant independent major predictors of small-bowel angioectasia. Type 1a angioectasias with oozing are indicated for PDI and type 1b angioectasias are indicated for PDI with APC or clipping.
Literature
1.
Li F, Leighton JA, Sharma VK. Capsule endoscopy in the evaluation of obscure gastrointestinal bleeding: a comprehensive review. Gastroenterol Hepatol. 2007;3:777–85.
2.
Lewis BS. Small intestinal bleeding. Gastroenterol Clin North Am. 1994;23:67–91.PubMed
3.
Heine GD, Hadithi M, Groenen MJ, Kuipers EJ, Jacobs MA, Mulder CJ. Double balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy. 2006;38:42–8.CrossRefPubMed
4.
Jacobs MA, Mulder CJ. Double balloon endoscopy in GI hemorrhage. Gastrointest Endosc. 2007;66:S60–2.CrossRefPubMed
5.
Ohmiya N, Yano T, Yamamoto H, Arakawa D, Nakamura M, Honda W, et al. Diagnosis and treatment of obscure GI bleeding at double balloon endoscopy. Gastrointest Endosc. 2007;66:S72–7.CrossRefPubMed
6.
Schmit A, Gay F, Adler M, Cremer M, Van Gossum A. Diagnostic efficacy of push-enteroscopy and long-term follow-up of patients with small bowel angiodysplasias. Dig Dis Sci. 1996;41:2348–52.CrossRefPubMed
7.
Yano T, Yamamoto H, Sunada K, Miyata T, Iwamoto M, Hayashi Y, et al. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc. 2008;67:169–72.CrossRefPubMed
8.
Fan GW, Chen TH, Lin WP, Su MY, Sung CM, Hsu CM, et al. Angiodysplasia and bleeding in the small intestine treated by balloon-assisted enteroscopy. J Dig Dis. 2013;14:113–6.CrossRefPubMed
9.
Li X, Chen H, Dai J, Gao Y, Ge Z. Predictive role of capsule endoscopy on the insertion route of double-balloon enteroscopy. Endoscopy. 2009;41:762–6.CrossRefPubMed
10.
Regula J, Wronska E, Pachlewski J. Vascular lesions of the gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2008;22:313–28.CrossRefPubMed
11.
Junquera F, Saperas E, de Torres I, Vidal MT, Malagelada JR. Increased expression of angiogenic factors in human colonic angiodysplasia. Am J Gastroenterol. 1999;94:1070–6.CrossRefPubMed
12.
Roskell DE, Biddolph SC, Warren BF. Apparent deficiency of mucosal vascular collagen type IV associated with angiodysplasia of the colon. J Clin Pathol. 1998;51:18–20.CrossRefPubMedPubMedCentral
13.
Heyde EC. Gastrointestinal bleeding in aortic stenosis. N Engl J Med. 1958;259:196.
14.
Chalasani N, Cotsonis G, Wilcox CM. Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia. Am J Gastroenterol. 1996;91:2329–32.PubMed
15.
Rosborough TK, Swaim WR. Acquired von Willebrand’s disease, platelet-release defect and angiodysplasia. Am J Med. 1978;65:96–100.CrossRefPubMed
16.
De Palma GD, Rega M, Masone S, Persico F, Siciliano S, Patrone F, et al. Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: a capsule endoscopy study. Gastrointest Endosc. 2005;62:529–34.CrossRefPubMed
17.
Akyuz F, Pinarbasi B, Ermis F, Uyanikoglu A, Demir K, Ozdil S, et al. Is portal hypertensive enteropathy an important additional cause of blood loss in portal hypertensive patients? Scand J Gastroenterol. 2010;45:1497–502.CrossRefPubMed
18.
Aoyama T, Oka S, Aikata H, Nakano M, Watari I, Naeshiro N, et al. Small bowel abnormalities in patients with compensated liver cirrhosis. Dig Dis Sci. 2013;58:1390–6.CrossRefPubMed
19.
Aoyama T, Oka S, Aikata H, Igawa A, Nakano M, Naeshiro N, et al. Major predictors of portal hypertensive enteropathy in patients with liver cirrhosis. J Gastroenterol Hepatol. 2015;30:124–30.CrossRefPubMed
20.
Mylonaki M, Fritscher − Ravens A, Swain P. Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding. Gut. 2003;52:1122–6.CrossRefPubMedPubMedCentral
21.
Delvaux M, Fassler I, Gay G. Clinical usefulness of the endoscopic video capsule as the initial intestinal investigation in patients with obscure digestive bleeding: validation of a diagnostic strategy based on the patient outcome after 12 months. Endoscopy. 2004;36:1067–73.CrossRefPubMed
22.
Imagawa H, Oka S, Tanaka S, Noda I, Higashiyama M, Sanomura Y, et al. Improved visibility of lesions of the small intestine via capsule endoscopy with computed virtual chromoendoscopy. Gastrointest Endosc. 2011;73:299–306.CrossRefPubMed
23.
Imagawa H, Oka S, Tanaka S, Noda I, Higashiyama M, Sanomura Y, et al. Improved detectability of small-bowel lesions via capsule endoscopy with computed virtual chromoendoscopy: a pilot study. Scand J Gastroenterol. 2011;46:1133–7.CrossRefPubMedPubMedCentral
24.
Maeda M, Hiraishi H. Efficacy of video capsule endoscopy with flexible spectral imaging color enhancement at setting 3 for differential diagnosis of red spots in the small bowel. Dig Endosc. 2014;26:228–31.CrossRefPubMed
25.
Shishido T, Oka S, Tanaka S, Aoyama T, Watari I, Imagawa H, et al. Diagnostic yield of capsule endoscopy vs. double-balloon endoscopy for patients who have undergone total enteroscopy with obscure gastrointestinal bleeding. Hepatogastroenterology. 2012;59:955–9.PubMed
26.
Postgate A, Despott E, Burling D, Gupta A, Phillips R, O’Beirne J, et al. Significant small-bowel lesions detected by alternative diagnostic modalities after negative capsule endoscopy. Gastrointest Endosc. 2008;68:1209–14.CrossRefPubMed
27.
Jensen LS, Dybdahl H, Juhl C, Nielsen TH. Endoscopic sclerotherapy of esophageal varices in an experimental animal model. A histomorphologic study. Scand J Gastroenterol. 1986;21:725–32.CrossRefPubMed
28.
Soehendra N, Grimm H, Stenzel M. Injection of nonvariceal bleeding lesions of the upper gastrointestinal tract. Endoscopy. 1985;17:129–32.CrossRefPubMed
29.
Okano H, Nishida H, Imamura M, Uchida S, Horiguchi Y, Sato T, et al. Endoscopic local injection of Aethoxysklerol to upper gastrointestinal bleeding. Gastroenterol Endosc. 1986;28:1233–6 [Article in Japanese].
30.
Takeuchi T, Narimiya N, Joki M, Iwasaki M, Sugimoto I, Watanabe T, et al. Experimental study on the effects of local injection of Aethoxysklerol for gastric mucosa with special reference to the submucosal arterial plexus. Gastroenterol Endosc. 1991;33:695–704 [Article in Japanese].
31.
Rahmi G, Samaha E, Vahedi K, Delvaux M, Gay G, Lamouliatte H, et al. Long-term follow-up of patients undergoing capsule and double-balloon enteroscopy for identification and treatment of small-bowel vascular lesions: a prospective, multicenter study. Endoscopy. 2014;46:591–7.CrossRefPubMed
Metadata
Title
Major predictors and management of small-bowel angioectasia
Authors
Atsushi Igawa
Shiro Oka
Shinji Tanaka
Sayoko Kunihara
Makoto Nakano
Taiki Aoyama
Kazuaki Chayama
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2015
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-015-0337-8

Other articles of this Issue 1/2015

BMC Gastroenterology 1/2015 Go to the issue

Research article

Cognitive-behavioural therapy has no effect on disease activity but improves quality of life in subgroups of patients with inflammatory bowel disease: a pilot randomised controlled trial

Research article

Risk of de novo post-transplant type 2 diabetes in patients undergoing liver transplant for non-alcoholic steatohepatitis

Case report

Early stage signet ring cell carcinoma of the colon examined by magnifying endoscopy with narrow-band imaging: a case report

Research article

Diagnostic accuracy of reused Pronto Dry® test and CLOtest® in the detection of Helicobacter pylori infection

Research article

WNT5A transforms intestinal CD8αα+ IELs into an unconventional phenotype with pro-inflammatory features

Case report

A case report of successful treatment of pyoderma gangrenosum in a patient with autoimmune hepatitis, and review of the literature

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits