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


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


METHODS
Tertiary-care referral center.


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


METHODS
DBE endotherapy.


METHODS
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).


CONCLUSIONS
Single-center, retrospective study.


CONCLUSIONS
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.
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Satoshi
S
Shinozaki
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Hironori
H
Yamamoto
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Tomonori
T
Yano
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Keijiro
K
Sunada
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Yoshikazu
Y
Hayashi
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Hakuei
H
Shinhata
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Hiroyuki
H
Sato
Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, United Kingdom.
Edward J
EJ
Despott
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Kentaro
K
Sugano
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult