Small Intestinal Angioectasia

Kaufman, Daniel; Leslie, Gregory; Marya, Neil B.; Han, Samuel; Gillespie, William; Holzwanger, Erik; Leslie, Richard; Cave, David R.

doi:10.1097/mcg.0000000000000663

Cited by 15 publications

(13 citation statements)

References 33 publications

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“…In this study, angioectasia was observed in the upper and middle portions, but not in the lower portion of the small bowel. Kaufman et al used a transit time-based quartile method to evaluate 158 patients with angioectasia who underwent CE and found that most lesions (67.1%) were in the first quartile [ 21 ]. Igawa et al reported that while there were no differences regarding the location of type 1a angioectasia among patients with occult gastrointestinal bleeding, type 1b angioectasia was relatively less frequent in the lower portion compared with that in the upper and middle portions of the small bowel [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Small-Bowel Lesions in Patients Taking Direct Oral Anticoagulants Detected Using Capsule Endoscopy

Yamaoka

Imaeda

Hosoe

et al. 2020

Gastroenterology Research and Practice

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Background and Aim. Direct oral anticoagulant- (DOAC-) induced small-bowel lesions have not been described. We evaluated small-bowel lesions related to DOAC using video capsule endoscopy (VCE). Methods. This study was a prospective, open-label, nonblinded, multicenter, and observational study. From September 2013 to March 2017, patients taking DOACs were enrolled. Patients underwent VCE. The type and location of small-bowel lesions were registered. Also, (1) the proportion of lesions detected between types of DOAC was evaluated and (2) the hemoglobin (Hb) and serum ferritin levels were compared between patients with and without small-bowel lesions. Results. 33 patients were enrolled, but 4 patients withdrew their consent, and VCE was performed on 29 patients. Eight, 13, and 8 patients received dabigatran, rivaroxaban, and apixaban, respectively. Small-bowel transit was complete in 27 of 29 patients (93.1%). Small-bowel lesions were detected in 23 (79.3%), redness in 12 (41.4%), erosions in 14 (48.3%), and angioectasia in 3 (10.3%) patients, and 6 patients (20.7%) had no abnormalities. Redness and erosions were detected in the upper, middle, or lower portions, but erosions tended to be less frequent in the middle portion (p=0.25, 0.06). Angioectasia was not detected in the lower portion. No patients had active bleeding. The findings did not differ according to the drug. The relationships between the endoscopic findings and the Hb and serum ferritin levels were not significant. Conclusion. Many patients taking DOACs had small-bowel lesions; however, most lesions were relatively mild. Observing small-bowel lesions over longer periods may be necessary in patients taking DOACs. This trial is registered with UMIN000011527.

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Section: Discussionmentioning

confidence: 99%

Small-Bowel Lesions in Patients Taking Direct Oral Anticoagulants Detected Using Capsule Endoscopy

Yamaoka

Imaeda

Hosoe

et al. 2020

Gastroenterology Research and Practice

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“…Although VCE has been recommended as the first-line investigation for SB bleeding, DAE still has an advantage over VCE for the histopathological confirmation of SB lesions and endoscopic hemostasis[ 2 , 3 ]. With regard to the source of SB bleeding, vascular lesions are the most common stigmata of hemorrhage, and DAE endotherapy has been considered as an efficient and safe treatment strategy[ 9 - 12 ]. Additionally, the rebleeding rate of SB vascular lesions is not low, especially in the elderly among individuals with active bleeding (identified by endoscopy), a history of aortic stenosis, or those in whom the bleeding source was angioectasia; the management of rebleeding using repeated endotherapy has favorable outcomes[ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…With regard to the source of SB bleeding, vascular lesions are the most common stigmata of hemorrhage, and DAE endotherapy has been considered as an efficient and safe treatment strategy[ 9 - 12 ]. Additionally, the rebleeding rate of SB vascular lesions is not low, especially in the elderly among individuals with active bleeding (identified by endoscopy), a history of aortic stenosis, or those in whom the bleeding source was angioectasia; the management of rebleeding using repeated endotherapy has favorable outcomes[ 9 , 10 ]. Among SB vascular lesions, arteriovenous malformation bleeding can be life-threatening; hence, prompt identification and timely intervention are very important[ 13 - 16 ].…”

Section: Discussionmentioning

confidence: 99%

Emergent single-balloon enteroscopy for overt bleeding of small intestinal vascular malformation

Chung

Chen

Chou

et al. 2018

WJG

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A 28-year-old man presented with anemia symptoms and intermittent tarry stool passage for three days. No stigmata of hemorrhage were identified using esophagogastroduodenoscopy, ileocolonoscopy, and contrast-enhanced computed tomography. He then developed massive tarry stool passage with profound hypovolemic shock and hypoxic respiratory failure. Emergent angiography revealed active bleeder, probably from the jejunal branches of the superior mesenteric artery, but embolization was not performed due to possible subsequent extensive bowel ischemia. His airway was secured via endotracheal intubation with ventilator support, and emergent antegrade single-balloon enteroscopy was performed at 8 h after clinical overt bleeding occurrence; the procedure revealed a 2-cm pulsating subepithelial tumor with a protruding blood plug at the distal jejunum. Laparoscopic segmental resection of the jejunum with end-to-end anastomosis was performed after emergent endoscopic tattooing localization. Pathological examination revealed a vascular malformation in the submucosa with an organizing thrombus. He was uneventfully discharged 5 d later. This case report highlights the benefit of early deep enteroscopy for the treatment of small intestinal bleeding.

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“…Lastly, risk factors for rebleeding attributed to AE were summarized from six studies (primarily utilizing capsule endoscopy and small bowel enteroscopy) in which rebleeding was associated with cirrhosis, a bleeding locus in the distal small bowel, and multiple AE. Unfortunately, since the contribution of endoscopic treatment toward the achievement of hemostasis was not uniformly collected in these studies, no further data were available regarding the understanding of the contribution of endoscopic cauterization toward the reduction of rebleeding risk [17]. Further studies will be required to quantify the benefit of endoscopic therapies, in particular those delivered to small bowel AE, and reductions in rebleeding risk.…”

mentioning

confidence: 99%

Risk Stratification of Angioectasia as a Cause of Gastrointestinal Bleeding: Untangling the Spider’s Web?

Micić

Sengupta

2019

Dig Dis Sci

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Small Intestinal Angioectasia

Abstract: These data help improve our knowledge of AEs regarding risk factors for rebleeding, and utilizes a novel small bowel transit time-based quartile localization method that may simplify future research and comparisons of anatomic distribution and behavior of small bowel AEs.

Cited by 15 publications

References 33 publications

Small-Bowel Lesions in Patients Taking Direct Oral Anticoagulants Detected Using Capsule Endoscopy

Small-Bowel Lesions in Patients Taking Direct Oral Anticoagulants Detected Using Capsule Endoscopy

Emergent single-balloon enteroscopy for overt bleeding of small intestinal vascular malformation

Risk Stratification of Angioectasia as a Cause of Gastrointestinal Bleeding: Untangling the Spider’s Web?

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