Year 2020 / Volume 112 / Number 4
Original
A comprehensive systematic review and meta-analysis of risk factors for rebleeding following device-assisted enteroscopy therapy of small-bowel vascular lesions

249-257

DOI: 10.17235/reed.2020.6802/2019

Enrique Pérez-Cuadrado Robles, Guillaume Perrod, Tom G Moreels, Luis Eduardo Zamora Nava, Gerardo Blanco Velasco, Pilar Esteban Delgado, Elia Samaha, Óscar Victor Hernández-Mondragón, Gabriel Rahmi, Christophe Cellier,

Abstract
Introduction: the aim of this study was to determine the risk factors for rebleeding following device-assisted enteroscopy therapy of small bowel vascular lesions. Methods: this is a systematic review and meta-analysis. A literature search was performed from January 2003 to October 2019. All studies reporting on at least one risk factor for bleeding recurrence after endoscopic therapy of small bowel vascular lesions were included. A meta-analysis of those risk factors reported in at least three studies was performed to assess their association with rebleeding. The OR and 95 % CI were used for binary outcome data. Heterogeneity analysis was performed using the Tau and I2 index. If I2 > 20 %, potential sources of heterogeneity were identified by sensitivity analyses and a random-effect model was used. Results: the search identified a total of 572 articles and 35 full-text records were assessed for eligibility after screening. Finally, eight studies that included 548 patients were selected. The overall median rebleeding rate was 38.5 % (range: 10.9-53.3 %) with a median follow-up of 24.5 months. Female sex (OR: 1.96, 95 % CI: 1.14-3.37, p = 0.01, I2 = 0 %), Osler-Weber syndrome (OR: 4.35, 95 % CI: 1.22-15.45, p = 0.02, I2 = 0 %) and cardiac disease (OR: 1.89, 95 % CI: 1.12-2.97, p = 0.005, I2: 0 %) were associated with rebleeding. According to the sensitivity analysis, overt bleeding (OR: 2.13, 95 % CI: 1.22-3.70, p = 0.007, I2 = 0 %), multiple lesions (OR: 4.57, 95 % CI: 2.04-10.22, p < 0.001, I2 = 0 %) and liver cirrhosis (OR: 2.61, 95 % CI: 1.11-6.13, p = 0.03, I2 = 0 %) were also predictors for rebleeding. Conclusions: patient characteristics and comorbidities should be considered for follow-up patient management after effective device-assisted endoscopic therapy, as they can predict rebleeding.
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References
[1] Pérez-Cuadrado-Robles E, Esteban-Delgado P, Martínez-Andrés B et al. Diagnosis agreement between capsule endoscopy and double-balloon enteroscopy in obscure gastrointestinal bleeding at a referral center. Rev Esp Enferm Dig. 2015; 107(8):495-500.
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[11] Ponte A, Pérez-Cuadrado Robles E, Pinho R et al. High short-term rebleeding rate in patients undergoing a second endoscopic therapy for small-bowel angioectasias after recurrent bleeding. Rev Esp Enferm Dig. 2018; 110(2):88-93. doi: 10.17235/reed.2017.4872/2017.
[12] Byeon JS, Mann NK, Jamil LH et al. Is a repeat double balloon endoscopy in the same direction useful in patients with recurrent obscure gastrointestinal bleeding?. J Clin Gastroenterol. 2013; 47(6):496-500.
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[14] Jeon SR, Byeon JS, Jang HJ et al. Clinical outcome after enteroscopy for small bowel angioectasia bleeding: A Korean Associateion for the Study of Intestinal Disease (KASID) multiceter study. J Gastroenterol Hepatol. 2017; 32(2):388-394.
[15] Pinho R, Ponte A, Rodrigues A et al. Long-term rebleeding risk following endoscopic therapy of small-bowel vascular lesions with device-assisted enteroscopy. Eur J Gastroenterol Hepatol. 2016; 28(4):479-85.
[16] Igawa A, Oka S, Tanaka S et al. Major predictors and management of small-bowel angioectasia. BMC Gastroenterol. 2015; 25;15:108.
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[20] May A, Friesing-Sosnik T, Manner H et al. Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding. Endoscopy. 2011; 43(9):759-65.
[21] Shinozaki S, Yamamoto H, Yano T et al. Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy. Clin Gastroenterol Hepatol. 2010; 8(2):151-8.
[22] Yano T, Yamamoto H, Sunada K et al. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc. 2008; 67(1):169-72.
[23] Nardone G, Compare D, Martino A et al. Pharmacological treatment of gastrointestinal bleeding due to angiodysplasias: A position paper of the Italian Society of Gastroenterology (SIGE). Dig Liver Dis. 2018; 50(6):542-548
[24] López Rosés L, Álvarez B, González Ramírez A et al. Viability of single balloon enteroscopy performed under endoscopist-directed sedation. Rev Esp Enferm Dig. 2018; 110(4):240-245.
[25] Fan GW, Chen TH, Lin WP et al. Angiodysplasia and bleeding in the small intestine treated by balloon-assisted enteroscopy. J Dig Dis. 2013;14(3):113-6. d
[26] Sakai E, Endo H, Taguri M et al. Frequency and risk factors for rebleeding events in patients with small bowel angioectasia. BMC Gastroenterol. 2014; 28;14:200.
[27] Pérez-Cuadrado-Robles E, Pérez-Cuadrado-Martínez E. The Role of Emergency Endoscopy in Small Bowel Bleeding: A Review. GE Port J Gastroenterol. 2015; 18;23(2):84-90.
[28] Pinto-Pais T, Pinho R, Rodrigues A et al. Emergency single-balloon enteroscopy in overt obscure gastrointestinal bleeding: Efficacy and safety. United European Gastroenterol J. 2014; 2(6):490-6.
[1] Pérez-Cuadrado-Robles E, Esteban-Delgado P, Martínez-Andrés B et al. Diagnosis agreement between capsule endoscopy and double-balloon enteroscopy in obscure gastrointestinal bleeding at a referral center. Rev Esp Enferm Dig. 2015; 107(8):495-500.
[2] Nennstiel S, Machanek A, von Delius S et al. Predictors and characteristics of angioectasias in patients with obscure gastrointestinal bleeding identified by video capsule endoscopy. United European Gastroenterol J. 2017 Dec;5(8):1129-1135.
[3] Yung DE, Koulaouzidis A, Avni T et al. Clinical outcomes of negative small-bowel capsule endoscopy for small-bowel bleeding: a systematic review and meta-analysis. Gastrointest Endosc. 2017; 85(2):305-317.e2
[4] Chami G, Raza M, Bernstein CN. Usefulness and impact on management of positive and negative capsule endoscopy. Can J Gastroenterol. 2007; 21(9):577-81
[5] Park JJ, Cheon JH, Kim HM et al. Negative capsule endoscopy without subsequent enteroscopy does not predict lower long-term rebleeding rates in patients with obscure GI bleeding. Gastrointest Endosc. 2010; 71(6):990-7.
[6] Niikura R, Yamada A, Nagata N et al. New predictive model of rebleeding during follow-up of patents with obscure gastrointestinal bleeding: A multicenter cohort study. J Gastroenterol Hepatol. 2016; 31(4):752-60.
[7] Uchida G, Nakamura M, Watanabe O et al. Risk factors for rebleeding and risk-based follow-up of obscure gastrointestinal bleeding after its initial diagnosis. Nihon Shokakibyo Gakkai Zasshi. 2017;114(10):1819-1829.
[8] Pennazio M, Spada C, Eliakim R et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2015; 47(4):352-76
[9] Romagnuolo J, Brock AS, Ranney N. Is Endoscopic Therapy Effective for Angioectasia in Obscure Gastrointestinal Bleeding?: A Systematic Review of the Literature. J Clin Gastroenterol. 2015; 49(10):823-30.
[10] Min YW, Kim JS, Jeon SW et al. Long-term outcome of capsule endoscopy in obscure gastrointestinal bleeding: a nationwide analysis. Endoscopy. 2014; 46(1):59-65
[11] Ponte A, Pérez-Cuadrado Robles E, Pinho R et al. High short-term rebleeding rate in patients undergoing a second endoscopic therapy for small-bowel angioectasias after recurrent bleeding. Rev Esp Enferm Dig. 2018; 110(2):88-93.
[12] Byeon JS, Mann NK, Jamil LH et al. Is a repeat double balloon endoscopy in the same direction useful in patients with recurrent obscure gastrointestinal bleeding?. J Clin Gastroenterol. 2013; 47(6):496-500.
[13] Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 20;5:13.
[14] Jeon SR, Byeon JS, Jang HJ et al. Clinical outcome after enteroscopy for small bowel angioectasia bleeding: A Korean Association for the Study of Intestinal Disease (KASID) multiceter study. J Gastroenterol Hepatol. 2017; 32(2):388-394.
[15] Pinho R, Ponte A, Rodrigues A et al. Long-term rebleeding risk following endoscopic therapy of small-bowel vascular lesions with device-assisted enteroscopy. Eur J Gastroenterol Hepatol. 2016; 28(4):479-85.
[16] Igawa A, Oka S, Tanaka S et al. Major predictors and management of small-bowel angioectasia. BMC Gastroenterol. 2015; 25;15:108.
[17] Rahmi G, Samaha E, Vahedi K 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(7):591-7.
[18] Shinozaki S, Yamamoto H, Yano T et al. Favorable long-term outcomes of repeat endotherapy for small-intestine vascular lesions by double-balloon endoscopy. Gastrointest Endosc. 2014; 80(1):112-7.
[19] Samaha E, Rahmi G, Landi B et al. Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions. Am J Gastroenterol. 2012; 107(2):240-6. d
[20] May A, Friesing-Sosnik T, Manner H et al. Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding. Endoscopy. 2011; 43(9):759-65.
[21] Shinozaki S, Yamamoto H, Yano T et al. Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy. Clin Gastroenterol Hepatol. 2010; 8(2):151-8.
[22] Yano T, Yamamoto H, Sunada K et al. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc. 2008; 67(1):169-72.
[23] Wells GA, Shea B, O’Connell D et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses 2014. Ottawa: Ottawa Hospital Research Institute; Available: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
[24] Nardone G, Compare D, Martino A et al. Pharmacological treatment of gastrointestinal bleeding due to angiodysplasias: A position paper of the Italian Society of Gastroenterology (SIGE). Dig Liver Dis. 2018; 50(6):542-548
[25] López Rosés L, Álvarez B, González Ramírez A et al. Viability of single balloon enteroscopy performed under endoscopist-directed sedation. Rev Esp Enferm Dig. 2018; 110(4):240-245.
[26] Fan GW, Chen TH, Lin WP et al. Angiodysplasia and bleeding in the small intestine treated by balloon-assisted enteroscopy. J Dig Dis. 2013;14(3):113-6. d
[27] Sakai E, Endo H, Taguri M et al. Frequency and risk factors for rebleeding events in patients with small bowel angioectasia. BMC Gastroenterol. 2014; 28;14:200.
[28] Pérez-Cuadrado-Robles E, Pérez-Cuadrado-Martínez E. The Role of Emergency Endoscopy in Small Bowel Bleeding: A Review. GE Port J Gastroenterol. 2015; 18;23(2):84-90.
[29] Pinto-Pais T, Pinho R, Rodrigues A et al. Emergency single-balloon enteroscopy in overt obscure gastrointestinal bleeding: Efficacy and safety. United European Gastroenterol J. 2014; 2(6):490-6.
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Pérez-Cuadrado Robles E, Perrod G, Moreels T, Zamora Nava L, Blanco Velasco G, Esteban Delgado P, et all. A comprehensive systematic review and meta-analysis of risk factors for rebleeding following device-assisted enteroscopy therapy of small-bowel vascular lesions. 6802/2019


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Publication history

Received: 09/12/2019

Accepted: 01/02/2020

Online First: 20/03/2020

Published: 07/04/2020

Article revision time: 51 days

Article Online First time: 102 days

Article editing time: 120 days


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