Year 2018 / Volume 110 / Number 2
Original
High short-term rebleeding rate in patients undergoing a second endoscopic therapy for small-bowel angioectasias after recurrent bleeding

88-93

DOI: 10.17235/reed.2017.4872/2017

Ana Ponte, Enrique Pérez-Cuadrado Robles, Rolando Pinho, Adélia Rodrigues, Pilar Esteban Delgado, Joana Silva, Jaime Rodrigues, João Carvalho, Enrique Pérez-Cuadrado Martínez,

Abstract
Background: Angioectasias represents the most frequently found lesion in the small bowel by device-assisted enteroscopy for obscure gastrointestinal bleeding in Western countries. Recurrence of gastrointestinal bleeding after angioectasias therapy remains unclear and data regarding the efficacy of additional endoscopic therapeutic sessions to reduce the rebleeding rate is limited. Aim: To evaluate the rebleeding rate in small bowel angioectasias after a second endoscopic treatment with balloon-assisted enteroscopy after an initial bleed during the first endoscopic treatment. Methods: A retrospective double-center study of patients with small-bowel angioectasias undergoing a second enteroscopy treatment due to a first rebleeding episode. The endpoint was rebleeding, defined as the need for a blood transfusion, the presence of overt bleeding or a decrease in hemoglobin ≥ 2 g/dL. Results: Fifteen of 37 (40.5%) patients with small-bowel angioectasias that underwent a second endoscopic therapy after a first rebleeding episode (n = 15) experienced a second rebleeding episode. Kaplan-Meier curve analysis showed that most rebleeding episodes occurred within the first 12 months of follow-up, resulting in a rebleeding rate of 33.1% at 6 months, 39.1% at 12 months and 52.6% at 24 months. Conclusions: Despite the high absolute short-term rebleeding rate, further endoscopic treatments may be beneficial due to the effective reduction of rebleeding in a subset of patients.
Share Button
New comment
Comments
No comments for this article
References
1. Min YW, Kim JS, Jeon SW, et al. Long-term outcome of capsule endoscopy in obscure gastrointestinal bleeding: a nationwide analysis. Endoscopy 2014;46:59-65.
2. 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;47:352-76.
3. Ribeiro I, Pinho R, Rodrigues A, et al. Obscure gastrointestinal bleeding: Which factors are associated with positive capsule endoscopy findings? Rev Esp Enferm Dig 2015;107:334-9.
4. Lecleire S, Iwanicki-Caron I, Di-Fiore A, et al. Yield and impact of emergency capsule enteroscopy in severe obscure-overt gastrointestinal bleeding. Endoscopy 2012;44:337-42.
5. Fisher LR, Hasler WL. New vision in video capsule endoscopy: current status and future directions. Nat Rev Gastroenterol Hepatol 2012;9:392-405.
6. 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;2:490-6.
7. Nadler M, Eliakim R. The role of capsule endoscopy in acute gastrointestinal bleeding. Therap Adv Gastroenterol 2014;7:87-92.
8. Gralnek IM. Obscure-overt gastrointestinal bleeding. Gastroenterology 2005;128:1424-30.
9. 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;28:479-85.
10. 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;46:591-7.
11. 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;107:240-6.
12. Curdia Goncalves T, Magalhaes J, Boal Carvalho P, et al. Is it possible to predict the presence of intestinal angioectasias? Diagn Ther Endosc 2014;2014:461602.
13. Jackson CS, Gerson LB. Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis. Am J Gastroenterol 2014;109:474-83; quiz 484.
14. Perez-Cuadrado Robles E, Bebia Conesa P, Esteban Delgado P, et al. Emergency double-balloon enteroscopy combined with real-time viewing of capsule endoscopy: a feasible combined approach in acute overt-obscure gastrointestinal bleeding? Dig Endosc 2015;27:338-44.
15. 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;43:759-65.
16. Yano T, Yamamoto H, Sunada K, et al. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc 2008;67:169-72.
17. 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;49:823-30.
18. Pinho R, Mascarenhas-Saraiva M, Mao-de-Ferro S, et al. Multicenter survey on the use of device-assisted enteroscopy in Portugal. United European Gastroenterol J 2016;4:264-74.
19. Bollinger E, Raines D, Saitta P. Distribution of bleeding gastrointestinal angioectasias in a Western population. World J Gastroenterol 2012;18:6235-9.
20. Robles EP. Emergency Capsule Endoscopy and Balloon-Assisted Enteroscopy may be a First-Line Procedure in Massive Acute Overt-Obscure Gastrointestinal Bleeding. Am J Gastroenterol 2016;111:294.
21. Fernandes C, Pinho R, Rodrigues A, et al. Argon plasma coagulation of a bleeding angioectasia in a jejunal diverticulum by single-balloon enteroscopy. Endoscopy 2015;47 Suppl 1 UCTN:E62.
22. 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;8:495-500.
23. Gerson LB, Batenic MA, Newsom SL, et al. Long-term outcomes after double-balloon enteroscopy for obscure gastrointestinal bleeding. Clin Gastroenterol Hepatol 2009;7:664-9.
Citation tools
Ponte A, Pérez-Cuadrado Robles E, Pinho R, Rodrigues A, Esteban Delgado P, Silva J, et all. High short-term rebleeding rate in patients undergoing a second endoscopic therapy for small-bowel angioectasias after recurrent bleeding. 4872/2017


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 900 visits.
This article has been downloaded 231 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 29/01/2017

Accepted: 18/09/2017

Online First: 20/11/2017

Published: 31/01/2018

Article revision time: 231 days

Article Online First time: 295 days

Article editing time: 367 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology