Favorable long-term outcomes of repeat endotherapy for small-intestine vascular lesions by double-balloon endoscopy

Published:January 21, 2014DOI:https://doi.org/10.1016/j.gie.2013.11.029

      Background

      GI bleeding secondary to small-intestine vascular lesions (SIVLs) is associated with rebleeding despite initial hemostasis by endotherapy applied at double-balloon endoscopy (DBE).

      Objective

      To evaluate the long-term outcomes of DBE endotherapy of SIVL (as described by the Yano-Yamamoto classification). The impact of repeat DBE endotherapy for recurrent bleeding also was assessed.

      Design

      Retrospective cohort study. The mean (± standard deviation [SD]) follow-up period was 4.9 (± 1.7) years (range 2.4-9.1 years).

      Setting

      Tertiary-care referral center.

      Patients

      A total of 43 patients, who underwent 69 sessions of DBE endotherapy of SIVLs.

      Intervention

      DBE endotherapy.

      Main Outcome Measurements

      Frequency of overt rebleeding after the initial DBE endotherapy.

      Results

      Overt rebleeding occurred in 16 of 43 patients (37%). Patients with multiple SIVLs showed a significantly higher rate of overt rebleeding than did those with a solitary SIVL (12/23 [52%] vs 4/20 [20%]; P = .017). The trend toward frequency of rebleeding after the first DBE hemostasis appeared to be higher for patients with type 1a SIVLs than for those with type 1b or type 2 lesions: type 1a (8/16, 50%) versus type 1b (5/19, 26%) (P = .12) and type 1a (8/16, 50%) versus type 2 (2/7, 29%) (P = .31), respectively. In 12 of 16 patients (75%) who underwent repeat DBE endotherapy at each episode of overt rebleeding (median 3 times, range 2-6), the frequency of rebleeding decreased significantly after the first year of follow-up, as compared with the remaining 4 patients who did not undergo repeat DBE; mean (± SD) 0.12 (± 0.19) versus 0.52 (± 0.33) times per year per patient (P = .006).

      Limitations

      Single-center, retrospective study.

      Conclusion

      Although the presence of multiple SIVLs was associated with rebleeding, repeat DBE endotherapy resulted in an improved long-term outcome in patients with refractory SIVL bleeding.

      Abbreviations:

      CE (capsule endoscopy), DBE (double-balloon endoscopy), MGIB (mid-GI bleeding), OGIB (obscure GI bleeding), SIVL (small-intestine vascular lesion)
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      References

        • Fisher L.
        • Lee Krinsky M.
        • Anderson M.A.
        • et al.
        • ASGE Standards of Practice Committee
        The role of endoscopy in the management of obscure GI bleeding.
        Gastrointest Endosc. 2010; 72: 471-479
        • Ell C.
        • May A.
        Mid-gastrointestinal bleeding: capsule endoscopy and push-and-pull enteroscopy give rise to a new medical term.
        Endoscopy. 2006; 38: 73-75
        • Yamamoto H.
        • Sekine Y.
        • Sato Y.
        • et al.
        Total enteroscopy with a nonsurgical steerable double-balloon method.
        Gastrointest Endosc. 2001; 53: 216-220
        • Yamamoto H.
        • Kita H.
        • Sunada K.
        • et al.
        Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases.
        Clin Gastroenterol Hepatol. 2004; 2: 1010-1016
        • Kochhar G.S.
        • Sanaka M.R.
        • Vargo J.J.
        Therapeutic management options for patients with obscure gastrointestinal bleeding.
        Therap Adv Gastroenterol. 2012; 5: 71-81
        • Shinozaki S.
        • Yamamoto H.
        • Yano T.
        • et al.
        Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy.
        Clin Gastroenterol Hepatol. 2010; 8: 151-158
        • Raju G.S.
        • Gerson L.
        • Das A.
        • et al.
        American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding.
        Gastroenterology. 2007; 133: 1697-1717
        • Shinozaki S.
        • Yamamoto H.
        • Yano T.
        • et al.
        Author reply to Timing, timing, timing of deep enteroscopy! A key factor for diagnosis of small intestinal hemorrhage, but does it impact patient outcomes?.
        Gastroenterology. 2010; 139: 2217
        • 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
        • Gerson L.B.
        • Batenic M.A.
        • Newsom S.L.
        • et al.
        Long-term outcomes after double-balloon enteroscopy for obscure gastrointestinal bleeding.
        Clin Gastroenterol Hepatol. 2009; 7: 664-669
        • Samaha E.
        • Rahmi G.
        • Landi B.
        • et al.
        Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions.
        Am J Gastroenterol. 2012; 107: 240-246
        • Gerson L.B.
        Is there a role for angiography in patients with obscure overt bleeding [editorial]?.
        Am J Gastroenterol. 2012; 107: 1377-1379