Small Bowel Angioectasias Rebleeding and the Identification of Higher Risk Patients

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors

Contributions

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.

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

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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). https://doi.org/10.1007/s10620-020-06137-1

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Keywords

  • Anemia
  • Melena
  • Capsule endoscopy
  • Hemorrhage
  • Angiodysplasia