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Do Clinical Characteristics Predict the Presence of Small Bowel Angioectasias on Capsule Endoscopy?

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Abstract

Background and Aims

Angioectasias (AVMs) are the most common vascular anomaly of the gastrointestinal (GI) tract, and these lesions are often associated with obscure gastrointestinal bleeding (OGIB). It is unknown if the presence of upper and/or lower gastrointestinal AVMs are predictive of small bowel AVMs. The aims of this study are to define the small bowel segmental distribution of AVMs and to identify the factors predicting the presence of small bowel AVMs among a cohort of patients with a known history of AVMs in the upper and/or lower GI tracts who are undergoing capsule endoscopy (CE) for OGIB.

Methods

We performed a retrospective cohort analysis of 1,125 patients undergoing CE at our institution between 11/1/2001 and 8/31/2007. Inclusion criteria were: (1) complete esophagoduodenoscopy (EGD), CE, and colonoscopy, (2) OGIB indication for CE, and (3) history of ≥1 AVM on EGD and/or colonoscopy that was previously treated in the past or deemed not to be a clinically significant source of bleeding. Exclusion criteria were: (1) history of radiation therapy to the GI tract, and (2) presence of a congenital or systemic disease associated with GI AVMs. Data were extracted on: (1) age; (2) gender; (3) presence of diabetes, (4) presence of hypertension, (5) presence of aortic stenosis, (6) history of non-steroidal anti-inflammatory therapy, (7) history of anticoagulant therapy, (8) hemoglobin, platelet, and INR values prior to CE; (9) baseline serum creatinine; and (10) presence and GI tract segmental location of AVMs. Multivariate logistic regression was used to identify independent predictors of small bowel AVMs.

Results

1,125 patients underwent EGD, CE, and colonoscopy. One hundred and fourteen patients had a history of ≥1 AVM on EGD and/or colonoscopy and met inclusion and exclusion criteria. The mean age was 69 years, and 63% of patients were women. 37% of patients were found to have ≥1 jejunal AVM and 15% were found to have ≥1 ileal AVM. In multivariate analysis, age ≥ 65 (OR 2.62, P = 0.05) and the presence of AVMs on EGD (OR 4.61, P = 0.02) were predictive of jejunal AVMs. AVMs on colonoscopy alone were not predictive of jejunal or ileal AVMs. No factors were found to predict the presence of ileal AVMs.

Conclusions

Patients with AVMs on EGD have an increased risk of jejunal AVMs on CE, particularly if they are elderly. Future studies should validate these findings in a prospective cohort.

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Abbreviations

AGA:

American gastroenterological association

AVM:

Angioectasia

CE:

Capsule endoscopy

DBE:

Double-balloon enteroscopy

EGD:

Esophagoduodenoscopy

GI:

Gastrointestinal

vWF:

von Willebrand’s factor

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Acknowledgments

We would like to thank Brian Burtraw, Mark McDermott, and Jason Baker (University of Michigan Health System Gastrointestinal Physiology Laboratory Technicians) for their assistance in the management of our CE data.

Conflict of interest

The authors declare no conflicts of interests associated with the creation of this manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA

    Anthony T. DeBenedet, Sameer D. Saini, Mimi Takami & Laurel R. Fisher

  2. Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA

    Anthony T. DeBenedet, Mimi Takami & Laurel R. Fisher

  3. Center for Clinical Management Research, Ann Arbor VA HSR&D Center of Excellence, Ann Arbor, MI, 48105, USA

    Sameer D. Saini

  4. Alfred Taubman Health Care Center, 1500 East Medical Center Drive, Room 3912, Ann Arbor, MI, 48109, USA

    Laurel R. Fisher

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  1. Anthony T. DeBenedet
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Correspondence to Laurel R. Fisher.

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DeBenedet, A.T., Saini, S.D., Takami, M. et al. Do Clinical Characteristics Predict the Presence of Small Bowel Angioectasias on Capsule Endoscopy?. Dig Dis Sci 56, 1776–1781 (2011). https://doi.org/10.1007/s10620-010-1506-9

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