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Nationwide cohort study identifies clinical outcomes of angioectasia in patients with acute hematochezia

  • Original Article—alimentary Tract
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Abstract

Background

While angioectasia is an important cause of acute hematochezia, relevant clinical features remain unclear. This study aims to reveal risk factors, clinical outcomes, and the effectiveness of therapeutic endoscopy for patients with acute hematochezia due to angioectasia.

Methods

This retrospective cohort study was conducted at 49 Japanese hospitals between January 2010 and December 2019, enrolling patients hospitalized for acute hematochezia (CODE BLUE-J study). Baseline factors and clinical outcomes for angioectasia were analyzed.

Results

Among 10,342 patients with acute hematochezia, 129 patients (1.2%) were diagnosed with angioectasia by colonoscopy. The following factors were significantly associated with angioectasia: chronic kidney disease, liver disease, female, body mass index < 25, and anticoagulant use. Patients with angioectasia were at a significant increased risk of blood transfusions compared to those without angioectasia (odds ratio [OR] 2.61; 95% confidence interval [CI] 1.69–4.02). Among patients with angioectasia, 36 patients (28%) experienced rebleeding during 1-year follow-up. The 1-year cumulative rebleeding rates were 37.0% in the endoscopic clipping group, 14.3% in the coagulation group, and 32.8% in the conservative management group. Compared to conservative management, coagulation therapy significantly reduced rebleeding risk (P = 0.038), while clipping did not (P = 0.81). Multivariate analysis showed coagulation therapy was an independent factor for reducing rebleeding risk (hazard ratio [HR] 0.40; 95% CI 0.16–0.96).

Conclusions

Our data showed patients with angioectasia had a greater comorbidity burden and needed more blood transfusions in comparison with those without angioectasia. To reduce rebleeding risk, coagulation therapy can be superior for controlling hematochezia secondary to angioectasia.

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Abbreviations

ALGIB:

Acute lower gastrointestinal bleeding

APC:

Argon plasma coagulation

BMI:

Body mass index

CI:

Confidence interval

CKD:

Chronic kidney disease

DOAC:

Direct oral anticoagulant

eGFR:

Estimated glomerular filtration rate

HR:

Hazard ratio

OR:

Odds ratio

SRH:

Stigmata of recent hemorrhage

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Acknowledgements

The authors thank Yusuke Niisato, Yoshitaka Tange, Hirosumi Suzuki, Tsubasa Onoda, Yuya Hagiwara, Soma Fukuda, Satoshi Fukuda, Miki Tsuji, Miho Nagafuchi for their assistance in data collection. The authors would also like to thank Dr. Bryan J. Mathis of the University of Tsukuba International Medical Center for English language revision.

Funding

This work was partially supported by Grants from the Ministry of Health, Labour and Welfare, Japan (Grant number: 19HB1003), JSPS KAKENHI (JP17K09365 and 20K08366), Smoking Research Foundation, Takeda Science Foundation, Tokyo Medical University Cancer Research Foundation, Tokyo Medical University Research Foundation, and Grants-in-Aid for Research from the National Center for Global Health and Medicine (29-2001, 29-2004, 19A1011, 19A1022, 19A-2015, 29-1025, and 30-1020). The funders played no role in the study design, analysis, and decision to publish the manuscript.

Author information

Author notes

  1. Mariko Kobayashi and Shintaro Akiyama co-first authorship and contributed equally to this work.

Authors and Affiliations

  1. Division of Endoscopic Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan

    Mariko Kobayashi & Toshiaki Narasaka

  2. Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki, Japan

    Shintaro Akiyama, Toshiaki Narasaka & Kiichiro Tsuchiya

  3. Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

    Katsumasa Kobayashi

  4. Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan

    Atsushi Yamauchi

  5. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Atsuo Yamada

  6. Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan

    Jun Omori & Mitsuru Kaise

  7. Department of Gastroenterology, St. Luke’s International University, Tokyo, Japan

    Takashi Ikeya

  8. Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan

    Taiki Aoyama

  9. Department of Gastroenterology, Saga-Ken Medical Centre Koseikan, Saga, Japan

    Naoyuki Tominaga

  10. Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Yoshinori Sato

  11. Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan

    Takaaki Kishino

  12. Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan

    Naoki Ishii

  13. Department of Endoscopy, Nagoya University Hospital, Nagoya, Aichi, Japan

    Tsunaki Sawada

  14. Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Masaki Murata

  15. Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Akinari Takao

  16. Department of Gastroenterology, Oita University, Oita, Japan

    Kazuhiro Mizukami

  17. Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan

    Ken Kinjo

  18. Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan

    Shunji Fujimori

  19. Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan

    Takahiro Uotani

  20. Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan

    Minoru Fujita

  21. Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

    Hiroki Sato

  22. Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan

    Sho Suzuki

  23. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan

    Junnosuke Hayasaka

  24. Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan

    Tomohiro Funabiki

  25. Emergency and Critical Care Center, Saiseikai Yokohama Tobu Hospital, Yokohama, Kanagawa, Japan

    Tomohiro Funabiki

  26. Department of Gastroenterology, Naha City Hospital, Naha, Okinawa, Japan

    Yuzuru Kinjo

  27. Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan

    Akira Mizuki

  28. Department of Gastroenterology, Shuto General Hospital, Yanai, Yamaguchi, Japan

    Shu Kiyotoki

  29. Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan

    Tatsuya Mikami

  30. Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Ryosuke Gushima

  31. Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan

    Hiroyuki Fujii

  32. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Yuta Fuyuno

  33. Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan

    Naohiko Gunji

  34. Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Iwate, Japan

    Yosuke Toya

  35. Department of Internal Medicine, National Defense Medical College, Saitama, Japan

    Kazuyuki Narimatsu

  36. Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan

    Noriaki Manabe

  37. Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan

    Koji Nagaike

  38. Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan

    Tetsu Kinjo

  39. Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

    Yorinobu Sumida

  40. Department of Gastroenterological Endoscopy, Fukuoka University Hospital, Fukuoka, Japan

    Sadahiro Funakoshi

  41. Department of Gastroenterology, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan

    Kiyonori Kobayashi

  42. Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan

    Tamotsu Matsuhashi

  43. Digestive and Lifestyle Diseases, and Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Yuga Komaki

  44. Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan

    Kuniko Miki & Naoyoshi Nagata

  45. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan

    Kazuhiro Watanabe & Naoyoshi Nagata

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  1. Mariko Kobayashi
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  2. Shintaro Akiyama
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Contributions

NN was the principal investigator and designed the study. MK (University of Tsukuba Hospital), SA, TN and NN conducted the literature search and conducted the study. MK (University of Tsukuba Hospital) and SA performed all data analysis and created all figures and tables. MK (University of Tsukuba Hospital), SA, TN, KK (Bokutoh hospital), AY, JO, TI, TA (Hiroshima City Asa Citizens Hospital), NT, YS (St Marianna University School of Medicine), TK, NI, TS, MM, AT, KM, KK (Fukuoka University Chikushi Hospital), SF, TU, MF, HS, SS, JH, TF, YK, AM, SK, TM, RG, HF, YF, NG, YT, KN (National Defense Medical College), NM, KN (Suita Municipal Hospital), TK, YS (National Hospital Organization Kyushu Medical Center), SF, KK (Kitasato University), TM, YK, KM, KW and MK (Nippon Medical School) collected and interpreted the data. MK (University of Tsukuba Hospital), SA and NN drafted the article. MK (University of Tsukuba Hospital), SA, TN, NI, KT and NN critically revised. All authors read and approved the submitted version of the manuscript.

Corresponding author

Correspondence to Toshiaki Narasaka.

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Kobayashi, M., Akiyama, S., Narasaka, T. et al. Nationwide cohort study identifies clinical outcomes of angioectasia in patients with acute hematochezia. J Gastroenterol 58, 367–378 (2023). https://doi.org/10.1007/s00535-022-01945-w

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