Diagnostic efficacy of push-enteroscopy and long-term follow-up of patients with small bowel angiodysplasias.
Gastrointestinal angiodysplasias are the most common cause of obscure chronic digestive blood loss. Push-enteroscopy is likely to detect and to treat vascular lesions. Push-enteroscopy was performed in 83 patients (mean age 62 years) presenting with iron deficiency anemia of obscure origin. A nonrevealing preliminary evaluation included esophagogastroduodenoscopy, colonoscopy and, in 50% of the patients, small bowel barium studies. We employed a 240-cm Olympus push-enteroscope (XSIF-100), 11.3 mm in diameter. A potential bleeding lesion was observed in 49 patients (59%). Gastrointestinal angiodysplasias were the most common lesion (33 patients). Electrocoagulation (bicap) of angiodysplasias was performed when accessible and not diffuse (<20). If not contraindicated, hormonal treatment was proposed for patients who had at least five AD. Some patients had both treatments. Long-term follow-up (mean, 12.2 months) was obtained in 25 patients with small bowel angiodysplasias. A good outcome (neither recurrence of anemia nor blood transfusion requirements) was observed in 12 patients. The diagnostic efficacy of push-enteroscopy is high. Despite available and recommended therapeutic modalities, the long-term outcome was considered to be good in only 50% of the patients.
Schmit
A
A
Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium.
Gay
F
F
Adler
M
M
Cremer
M
M
Van Gossum
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016888:Angiodysplasia / Q000175:diagnosis* / Q000628:therapy; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004564:Electrocoagulation; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004997:Ethinyl Estradiol / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000628:therapy; D007421:Intestine, Small; D008297:Male; D008551:Melena / Q000209:etiology; D008875:Middle Aged; D009640:Norethindrone / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077563:Norethindrone Acetate; D009652:Norpregnenes / Q000008:administration & dosage; D045167:Progesterone Congeners / Q000008:administration & dosage; D012189:Retrospective Studies; D016896:Treatment Outcome
D009652:Norpregnenes; D045167:Progesterone Congeners; C033273:Gestodene; D004997:Ethinyl Estradiol; D000077563:Norethindrone Acetate; D009640:Norethindrone