Skip to main content


Log in

Small Bowel Angioectasias Rebleeding and the Identification of Higher Risk Patients

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript



Small bowel capsule endoscopy (SBCE) is the gold standard for suspected small bowel bleeding (SBB). Angioectasias are the most common vascular anomalies in the gastrointestinal tract and have been reported as the source of SBB in up to 80% of patients. Considering their frequency, their usual intermittent bleeding nature, and their risk of rebleeding, the aim of this study was to identify some features and possible predictors of rebleeding in the presence of these lesions.


This is a retrospective study, which included consecutive SBCE with angioectasias between April 2008 and December 2017 with a minimum follow-up of 12 months. Rebleeding was defined as a drop of hemoglobin ≥ 2 g/dl and/or in the presence of hematochezia or melenas with negative esophagogastroduodenoscopy and ileocolonoscopy. Data were collected from medical records, and angioectasias were classified by number, location, size, and type. Univariate and multivariable statistical analysis was performed to identify possible predictors of rebleeding.


From a total of 630 patients submitted to SBCE for suspected SBB, 129 with angioectasias were included; 59.7% were female, with a median age of 72 (19–91) years old and a mean follow-up of 44.0 ± 31.9 months. In 32.6% (n = 42) of the patients, at least one episode of rebleeding was documented. The presence of heart failure (OR 3.41; IC95% 1.18–9.89; p = 0.024), the size of the angioectasias (OR 5.41; IC95% 2.15–13.6; p < 0.001), and smoking status (OR 3.15; IC95% 1.07–9.27; p = 0.038) were independent predictor factors of rebleeding.


Heart failure, smoking status, and angioectasias with a size superior to 5 mm are independent predictor factors of rebleeding in a population with angioectasias diagnosed by SBCE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Gerson LB, Fidler JL, Cave DR, Leighton JA. ACG clinical guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol. 2015;110:1265–1287. (quiz 88).

    Article  CAS  Google Scholar 

  2. Rondonotti E, Spada C, Adler S, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) technical review. Endoscopy. 2018;50:423–446.

    Article  Google Scholar 

  3. Gunjan D, Sharma V, Rana SS, Bhasin DK. Small bowel bleeding: a comprehensive review. Gastroenterol Rep. 2014;2:262–275.

    Article  Google Scholar 

  4. Rosa B, Cotter J. Current clinical indications for small bowel capsule endoscopy. Acta Med Port. 2015;28:632–639.

    Article  Google Scholar 

  5. Dionisio PM, Gurudu SR, Leighton JA, et al. Capsule endoscopy has a significantly higher diagnostic yield in patients with suspected and established small-bowel Crohn’s disease: a meta-analysis. Am J Gastroenterol. 2010;105:1240–1248. quiz 9.

    Article  Google Scholar 

  6. Zhang QHQ, Liu J, Ma F, Zhi F, Bai Y. Combined use of capsule endoscopy and double-balloon enteroscopy in the diagnosis of obscure gastrointestinal bleeding: meta-analysis and pooled analysis. Hepato-gastroenterology. 2013;60:1885–1891.

    PubMed  Google Scholar 

  7. Liao Z, Gao R, Xu C, Li ZS. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc. 2010;71:280–286.

    Article  Google Scholar 

  8. Chetcuti Zammit S, Koulaouzidis A, Sanders DS, et al. Overview of small bowel angioectasias: clinical presentation and treatment options. Expert Rev Gastroenterol Hepatol. 2018;12:125–139.

    Article  CAS  Google Scholar 

  9. Ponte A, Perez-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 enfermedades dig organo of Soc Esp Patol Dig. 2018;110:88–93.

    Google Scholar 

  10. Yano T, Yamamoto H, Sunada K, et al. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc. 2008;67:169–172.

    Article  Google Scholar 

  11. Cúrdia Gonçalves TMJ, Boal Carvalho P, Moreira MJ, Rosa B, Cotter J. Is it possible to predict the presence of intestinal angioectasias? Diagn Ther Endosc. 2014;2014:461602.

    Article  Google Scholar 

  12. 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 Eur Gastroenterol J. 2017;5:1129–1135.

    Article  Google Scholar 

  13. Igawa A, Oka S, Tanaka S, et al. Major predictors and management of small-bowel angioectasia. BMC Gastroenterol. 2015;15:108.

    Article  Google Scholar 

  14. Yamada A, Niikura R, Kobayashi Y, et al. Risk factors for small bowel angioectasia: the impact of visceral fat accumulation. World J Gastroenterol. 2015;21:7242–7247.

    Article  Google Scholar 

  15. Zajjari YTM, Montasser D, Hassani K, Aatif T, El Kabbaj D, Benyahia M. Gastrointestinal bleeding due to angioectasia in patients on hemodialysis: a single center study. Saudi J Kidney Dis Transpl. 2016;27:748–751.

    Article  Google Scholar 

  16. Romagnuolo J, Brock AS, Ranney N. Is endoscopic therapy effective for angioectasia in obscure gastrointestinal bleeding? A systematic review of literature. J Clin Gastroenterol. 2015;49:823–830.

    Article  CAS  Google Scholar 

  17. 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;28:479–485.

    Article  Google Scholar 

  18. Curdia Goncalves T, Arieira C, Monteiro S, Rosa B, Moreira MJ, Cotter J. ORBIT score: an useful predictor of small bowel rebleeding in patients under chronic anticoagulation. Scand J Gastroenterol. 2018;53:179–184.

    Article  Google Scholar 

  19. Curdia Goncalves T, Dias de Castro F, Moreira MJ, Rosa B, Cotter J. Small bowel capsule endoscopy in obscure gastrointestinal bleeding: normalcy is not reassuring. Eur J Gastroenterol Hepatol. 2014;26:927–932.

    Article  Google Scholar 

  20. 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;31:752–760.

    Article  CAS  Google Scholar 

  21. Kaufman D, Leslie G, Marya N, et al. Small intestinal angioectasia: characterization, risk factors, and rebleeding. J Clin Gastroenterol. 2017;51:720–727.

    Article  Google Scholar 

  22. Sakai E, Endo H, Taguri M, et al. Frequency and risk factors for rebleeding events in patients with small bowel angioectasia. BMC Gastroenterol. 2014;14:200.

    Article  Google Scholar 

  23. Redondo-Cerezo E, Gomez-Ruiz CJ, Sanchez-Manjavacas N, et al. Long-term follow-up of patients with small-bowel angiodysplasia on capsule endoscopy. Determinants of a higher clinical impact and rebleeding rate. Rev esp enfermedades dig organo of Soc Esp Patol Dig. 2008;100:202–207.

    CAS  Google Scholar 

  24. Diggs NGHJ, Lieberman DA, Eisen GM, Strate L. Factors that contribute to blood loss in patients with colonic angiodysplasia from a population-based study. Clin Gastroenterol Hepatol. 2011;9:415–420.

    Article  Google Scholar 

  25. Xavier S, Magalhaes J, Rosa B, Moreira MJ, Cotter J. Impact of small bowel capsule endoscopy in iron deficiency anemia: influence of patient’s age on diagnostic yield. Arq Gastroenterol. 2018;55:242–246.

    Article  Google Scholar 

  26. Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. New evidence on the impact of antithrombotics in patients submitted to small bowel capsule endoscopy for the evaluation of obscure gastrointestinal bleeding. Gastroenterol Res Pract. 2014;2014:709217.

    Article  Google Scholar 

  27. Cho KM, Park SY, Chung JO, et al. Risk factors for small bowel bleeding in chronic nonsteroidal anti-inflammatory drug users. J Dig Dis. 2015;16:499–504.

    Article  CAS  Google Scholar 

  28. Ormeci AAF, Baran B, Gokturk S, et al. What is the impact of capsule endoscopy in the long term period? World J Gastrointest Endosc. 2016;8:344–348.

    Article  Google Scholar 

  29. Sidhu R, Sanders DS, Kapur K, Leeds JS, McAlindon ME. Factors predicting the diagnostic yield and intervention in obscure gastrointestinal bleeding investigated using capsule endoscopy. J Gastrointest Liver Dis JGLD. 2009;18:273–278.

    Google Scholar 

  30. Van Weyenberg SJ, Van Turenhout ST, Jacobs MA, Bouma G, Mulder CJ. Video capsule endoscopy for previous overt obscure gastrointestinal bleeding in patients using anti-thrombotic drugs. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2012;24:247–254.

    Google Scholar 

  31. Han S, Leslie G, Kaufman D, et al. Su1225 smoking as a potential risk factor for the development of angioectasias. Gastrointest Endosc. 2016;83:A318–A319.

    Google Scholar 

  32. Heer M, Sulser H, Hany A. Angiodysplasia of the colon: an expression of occlusive vascular disease. Hepato-gastroenterology. 1987;34:127–131.

    CAS  PubMed  Google Scholar 

  33. Iribarren C, Phelps BH, Darbinian JA, et al. Circulating angiopoietins-1 and -2, angiopoietin receptor Tie-2 and vascular endothelial growth factor-A as biomarkers of acute myocardial infarction: a prospective nested case-control study. BMC Cardiovasc Disord. 2011;11:31.

    Article  CAS  Google Scholar 

  34. Bauditz J, Lochs H. Angiogenesis and vascular malformations: antiangiogenic drugs for treatment of gastrointestinal bleeding. World J Gastroenterol. 2007;13:5979–5984.

    Article  CAS  Google Scholar 

  35. Holleran G, Hall B, Hussey M, McNamara D. Small bowel angiodysplasia and novel disease associations: a cohort study. Scand J Gastroenterol. 2013;48:433–438.

    Article  Google Scholar 

  36. Chetcuti Zammit S, Sanders DS, Sidhu R. Lanreotide in the management of small bowel angioectasias: seven-year data from a tertiary centre. Scand J Gastroenterol. 2017;52:962–968.

    CAS  PubMed  Google Scholar 

  37. Nardone G, Compare D, Martino A, Rocco A. Pharmacological treatment of gastrointestinal bleeding due to angiodysplasias: a position paper of the Italian Society of Gastroenterology (SIGE). Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2018;50:542–548.

    Google Scholar 

Download references



Author information

Authors and Affiliations



CA and FDC designed the study, interpreted the data, and drafted the manuscript. CA, RM, PBC, BR, and MJM reviewed the small bowel capsule endoscopies. CA, RM, PBC participated on the acquisition of data and performed the statistical analysis. FDC, PBC, BR, and MJM critically revised the manuscript. JC critically revised and approved the final version of the manuscript.

Corresponding author

Correspondence to Cátia Arieira.

Ethics declarations

Conflict of interest

Bruno Rosa has consulting services agreement with Medtronic®. Other authors have no conflict of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arieira, C., Magalhães, R., Dias de Castro, F. et al. Small Bowel Angioectasias Rebleeding and the Identification of Higher Risk Patients. Dig Dis Sci 66, 175–180 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: