High diagnostic and clinical impact of small-bowel capsule endoscopy in patients with hereditary hemorrhagic telangiectasia with overt digestive bleeding and/or severe anemia.
BACKGROUND
Patients with hereditary hemorrhagic telangiectasia (HHT) often present with recurrent anemia because of epistaxis or GI bleeding in relation to telangiectases mostly located in the stomach or small bowel. Capsule endoscopy is considered a major diagnostic tool for small-bowel diseases, but the impact of capsule endoscopy imaging on patient management in HHT is poorly understood.


OBJECTIVE
To clarify the contribution of capsule endoscopy in selected patients with HHT.


METHODS
Prospective, descriptive study.


METHODS
Multicenter, two university hospital tertiary-care centers, from January 2003 to June 2007.


METHODS
This study involved 30 patients with HHT and severe anemia (hemoglobin <9 g/dL; normal: 11-15 g/dL) and minimal epistaxis or moderate anemia but overt GI bleeding.


METHODS
Capsule endoscopy investigation.


METHODS
Clinical characteristics and capsule endoscopy results and their clinical consequences.


RESULTS
Capsule endoscopy detected gastric and small-bowel telangiectases in 14 (46.7%) and 26 (86.7%) cases, respectively. Active bleeding was present in 36.7% of cases. Diffuse telangiectases were detected in 42.3% without correlation with age, sex, or type of HHT mutation. Further investigations were carried out as a consequence of the capsule endoscopy results in 67% of cases. Treatment, consisting mostly of endoscopic argon plasma coagulation, was scheduled in 46.7% of patients.


CONCLUSIONS
Our population was essentially composed of patients with the ALK1 mutation.


CONCLUSIONS
This study shows that there is a high diagnostic yield for capsule endoscopy in selected patients with HHT. Capsule endoscopy makes possible precise mapping of lesions and has a considerable impact on the management of these selected patients by using a predefined algorithm: a limited number of accessible lesions is suitable for endoscopic treatment, whereas innumerable diffuse lesions require a medical approach. We suggest that capsule endoscopy could be a first-line, noninvasive, digestive tract examination in selected patients with HHT.
Grève
Emilie
E
Service de gastroentérologie et d'hépatologie, Centre Hospitalier Universitaire de Saint-Etienne, Hôpital Nord, Saint-Etienne, France.
Moussata
Driffa
D
Gaudin
Jean Louis
JL
Lapalus
Marie-Georges
MG
Giraud
Sophie
S
Dupuis-Girod
Sophie
S
Calender
Alain
A
Plauchu
Henri
H
Saurin
Jean-Christophe
JC
D030301:Activin Receptors, Type II / Q000235:genetics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis*; D053704:Capsule Endoscopy; D003937:Diagnosis, Differential; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D005838:Genotype; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000235:genetics; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000175:diagnosis* / Q000235:genetics
C425364:ACVRL1 protein, human; D030301:Activin Receptors, Type II