title: Is Endoscopic Therapy Effective for Angioectasia in Obscure Gastrointestinal Bleeding?: A Systematic Review of the Literature.
abstract: OBJECTIVE
  We aimed to summarize pooled rebleeding rates of angioectasia after therapeutic endoscopy, and compare these to historical control (no intervention) rates.
  
  
  BACKGROUND
  Obscure gastrointestinal bleeding continues to be challenging to diagnose and treat; in America, small bowel angioectasias are the most common cause. Technology advances led to higher diagnostic yield for these lesions; however, therapeutic impact of endoscopy remains unclear.
  
  
  METHODS
  A PubMed search (June 1, 2006 to September 19, 2013) with 2 independent reviews sought articles reporting rebleeding rates of symptomatic angioectasia without therapy (natural history) and after endoscopic treatment. This study list was added to studies in the 2007 American Gastroenterological Association systematic review. Data on number of patients who underwent endoscopic therapy, type of therapy used, number of patients who experienced rebleeding, and follow-up time were extracted. Rebleeding data were pooled and weighted averages were reported with 95% confidence intervals (CI).
  
  
  RESULTS
  Twenty-four articles (n=490 patients) with data on endoscopic therapy for angioectasia and 6 natural history cohorts (n=130) receiving no therapy for angioectasia were eligible. Of the endoscopic therapy patients, 121 at push enteroscopy and 427 at balloon-assisted enteroscopy; 209/490 (42.7%; 95% CI, 38%-47%) rebled. Of the control (no therapy) patients, 64/130 (49.2%; 95% CI, 40%-58%) rebled. Number needed to treat is estimated at 15 to 16.
  
  
  CONCLUSIONS
  Rebleeding rate after endoscopic therapy for symptomatic small bowel angioectasia may be comparable to that expected without therapy. Endoscopic therapy may be ineffective; if effective, the needed to treat is estimated to be high. Controlled studies, with intervention-stratified and etiology-stratified outcomes are needed.
authors.affiliation: *Department of Public Health Sciences, Medical University of South Carolina †Department of Medicine, Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC.
authors.forename: Joseph
authors.initials: J
authors.lastname: Romagnuolo
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Brock
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Ranney
mesh_terms: D000328:Adult; D016888:Angiodysplasia / Q000150:complications / Q000601:surgery*; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply* / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D012008:Recurrence; D016896:Treatment Outcome