Is It Possible to Predict the Presence of Intestinal Angioectasias?

Background and Aim. Angioectasias are the most common vascular anomalies found in the gastrointestinal tract. In small bowel (SB), they can cause obscure gastrointestinal bleeding (OGIB) and in this setting, small bowel capsule endoscopy (SBCE) is an important diagnostic tool. This study aimed to identify predictive factors for the presence of SB angioectasias, detected by SBCE. Methods. We retrospectively analyzed the results of 284 consecutive SBCE procedures between April 2006 and December 2012, whose indication was OGIB, of which 47 cases with SB angioectasias and 53 controls without vascular lesions were selected to enter the study. Demographic and clinical data were collected. Results. The mean age of subjects with angioectasias (70.9 ± 14.7) was significantly higher than in controls (53.1 ± 18.6; P < 0.001). The presence of SB angioectasias was significantly higher when the indication for the exam was overt OGIB versus occult OGIB (13/19 versus 34/81, P = 0.044). Hypertension and hypercholesterolemia were significantly associated with the presence of SB angioectasias (38/62 versus 9/38, P < 0.001 and 28/47 versus 19/53, P = 0.027, resp.). Other studied factors were not associated with small bowel angioectasias. Conclusions. In patients with OGIB, overt bleeding, older age, hypercholesterolemia, and hypertension are predictive of the presence of SB angioectasias detected by SBCE, which may be used to increase the diagnostic yield of the SBCE procedure and to reduce the proportion of nondiagnostic examinations.

[1]  C. Mulder,et al.  Video capsule endoscopy for previous overt obscure gastrointestinal bleeding in patients using anti‐thrombotic drugs , 2012, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[2]  M. Cappell,et al.  Changing epidemiology of gastrointestinal angiodysplasia with increasing recognition of clinically milder cases: angiodysplasia tend to produce mild chronic gastrointestinal bleeding in a study of 47 consecutive patients admitted from 1980-1989. , 1992, The American journal of gastroenterology.

[3]  G. Bresci.  Occult and obscure gastrointestinal bleeding: Causes and diagnostic approach in 2009. , 2009, World journal of gastrointestinal endoscopy.

[4]  J. Malagelada,et al.  Increased expression of angiogenic factors in human colonic angiodysplasia , 1999, American Journal of Gastroenterology.

[5]  N. Scott,et al.  Small Bowel Lymphangiectasia and Angiodysplasia: A Positive Association; Novel Clinical Marker or Shared Pathophysiology? , 2010, Journal of clinical gastroenterology.

[6]  P. Bedossa,et al.  Portal hypertensive colopathy , 1991, Digestive Diseases and Sciences.

[7]  M. Plebani,et al.  Chronic nicotine intake causes vascular dysregulation in the rat gastric mucosa. , 1993, Gut.

[8]  A. Nakajima,et al.  Clinical associations and risk factors for bleeding from colonic angiectasia: a case‐controlled study , 2012, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[9]  G. G. Stokes.  "J." , 1890, The New Yale Book of Quotations.

[10]  J. Malagelada,et al.  Capsule Endoscopy Versus Computed Tomographic or Standard Angiography for the Diagnosis of Obscure Gastrointestinal Bleeding , 2007, The American Journal of Gastroenterology.

[11]  Amy K Hara,et al.  Imaging of small bowel disease: comparison of capsule endoscopy, standard endoscopy, barium examination, and CT. , 2005, Radiographics : a review publication of the Radiological Society of North America, Inc.

[12]  Nikolaos Kalantzis,et al.  CAPSULE ENDOSCOPY FINDINGS IN PATIENTS WITH OCCULT OR OVERT BLEEDING OLDER THAN 80 YEARS , 2012, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[13]  Warwick Selby,et al.  Can clinical features predict the likelihood of finding abnormalities when using capsule endoscopy in patients with GI bleeding of obscure origin? , 2004, Gastrointestinal endoscopy.

[14]  Y. Hirooka,et al.  Preliminary Comparison of Capsule Endoscopy and Double-Balloon Enteroscopy in Patients with Suspected Small-Bowel Bleeding , 2006, Endoscopy.

[15]  Atsuo Yamada,et al.  Efficacy of flexible spectral imaging color enhancement on the detection of small intestinal diseases by capsule endoscopy , 2012, Journal of digestive diseases.

[16]  Aaas News,et al.  Book Reviews , 1893, Buffalo Medical and Surgical Journal.

[17]  A. Kaffes,et al.  Review article: the diagnosis and investigation of obscure gastrointestinal bleeding , 2011, Alimentary pharmacology & therapeutics.

[18]  S. Saini,et al.  Do Clinical Characteristics Predict the Presence of Small Bowel Angioectasias on Capsule Endoscopy? , 2011, Digestive Diseases and Sciences.

[19]  G. Rogler,et al.  Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small bowel disease , 2006, International Journal of Colorectal Disease.

[20]  P. Figueiredo,et al.  Virtual chromoendoscopy can be a useful software tool in capsule endoscopy. , 2012, Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva.

[21]  P. Rogalla,et al.  Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis. , 2003, Endoscopy.

[22]  B. Warren,et al.  Apparent deficiency of mucosal vascular collagen type IV associated with angiodysplasia of the colon. , 1998, Journal of clinical pathology.

[23]  R. Jian,et al.  Capsule endoscopy or push enteroscopy for first-line exploration of obscure gastrointestinal bleeding? , 2007, Gastroenterology.

[24]  K. Chayama,et al.  Improved detectability of small-bowel lesions via capsule endoscopy with computed virtual chromoendoscopy: A pilot study , 2011, Scandinavian journal of gastroenterology.

[25]  A. Hara,et al.  A Meta-Analysis of the Yield of Capsule Endoscopy Compared to Other Diagnostic Modalities in Patients with Obscure Gastrointestinal Bleeding , 2005, The American Journal of Gastroenterology.

[26]  M Pennazio,et al.  ICCE consensus for obscure gastrointestinal bleeding. , 2005, Endoscopy.

[27]  K. Geboes,et al.  Faculty Opinions recommendation of European Society of Gastrointestinal Endoscopy (ESGE): recommendations (2009) on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases. , 2011 .

[28]  W. Fleig,et al.  Transjugular intrahepatic portosystemic shunt for bleeding angiodysplasia-like lesions in portal-hypertensive colopathy. , 1998, Gastroenterology.

[29]  J. Beckman,et al.  Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I , 2013, European heart journal.

[30]  B. Petersen,et al.  ASGE Technology Status Evaluation Report: wireless capsule endoscopy. , 2006, Gastrointestinal endoscopy.

[31]  A novel three‐dimensional dynamic anorectal ultrasonography technique for the assessment of perineal descent, compared with defaecography , 2012, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[32]  J. Leighton,et al.  Capsule endoscopy in the evaluation of obscure gastrointestinal bleeding: a comprehensive review. , 2007, Gastroenterology & hepatology.

[33]  J. Féher,et al.  [Multiple angiodysplasias diagnosed by capsule endoscopy]. , 2007, Orvosi hetilap.

[34]  G. Galanopoulos.  Angiodysplastic lesions as a cause of colonic bleeding in patients with chronic renal disease: is there an association? , 2012, Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia.

[35]  E. Rondonotti,et al.  Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. , 2004, Gastroenterology.

[36]  N. Dhalla,et al.  Role of cholesterol in cardiovascular dysfunction. , 2004, The Canadian journal of cardiology.

[37]  Z. Liao,et al.  Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. , 2010, Gastrointestinal endoscopy.

[38]  J. Reguła,et al.  Vascular lesions of the gastrointestinal tract. , 2008, Best practice & research. Clinical gastroenterology.

[39]  Ananya Das,et al.  American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding. , 2007, Gastroenterology.

[40]  N. Hayashi,et al.  Jejunal varices as a cause of massive gastrointestinal bleeding. , 1992, The American journal of gastroenterology.

[41]  Y. Joo,et al.  Massive gastrointestinal bleeding from jejunal varices , 2000, Journal of Gastroenterology.

[42]  J. Rey,et al.  European Society of Gastrointestinal Endoscopy (ESGE): Recommendations (2009) on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases , 2010, Endoscopy.

[43]  M. Esaki,et al.  Factors Associated with the Clinical Impact of Capsule Endoscopy in Patients with Overt Obscure Gastrointestinal Bleeding , 2010, Digestive Diseases and Sciences.

[44]  N. Chalasani,et al.  Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia. , 1996, The American journal of gastroenterology.

[45]  T. Chiba,et al.  Clinical features of Japanese patients with colonic angiodysplasia , 2008, Journal of gastroenterology and hepatology.

[46]  Bedine,et al.  Textbook of gastroenterology , 2000, Gastroenterology.

[47]  Miss A.O. Penney.  (b) , 1974, The New Yale Book of Quotations.

[48]  Dirk Hartmann,et al.  A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding. , 2005, Gastrointestinal endoscopy.

[49]  O. Yokosuka,et al.  Negative capsule endoscopy for obscure gastrointestinal bleeding is closely associated with the use of low-dose aspirin , 2011, Scandinavian journal of gastroenterology.

[50]  R. Stephenson.  A and V , 1962, The British journal of ophthalmology.