title: Major predictors and management of small-bowel angioectasia.
abstract: BACKGROUND
  Small-bowel angioectasias are frequently diagnosed with capsule endoscopy (CE) or balloon endoscopy however, major predictors have not been defined and the indications for endoscopic treatment have not been standardized. The aim of this study was to evaluate the predictors and management of small-bowel angioectasia.
  
  
  METHODS
  Among patients with obscure gastrointestinal bleeding (OGIB) who underwent both CE and double-balloon endoscopy at our institution, we enrolled 64 patients with small-bowel angioectasia (angioectasia group) and 97 patients without small-bowel angioectasia (non-angioectasia group). The angioectasia group was subdivided into patients with type 1a angioectasia (35 cases) and type 1b angioectasia (29 cases) according to the Yano-Yamamoto classification. Patient characteristics, treatment, and outcomes were evaluated.
  
  
  RESULTS
  Age (P = 0.001), cardiovascular disease (P = 0.002), and liver cirrhosis (P = 0.003) were identified as significant predictors of small-bowel angioectasia. Multivariate logistic regression analysis identified cardiovascular disease (odds ratio 2.86; 95% confidence interval, 1.35-6.18) and liver cirrhosis (odds ratio 4.81; 95% confidence interval, 1.79-14.5) as independent predictors of small-bowel angioectasia. Eleven type 1a cases without oozing were treated conservatively, and 24 type 1a cases with oozing were treated with polidocanol injection (PDI). Re-bleeding occurred in two type 1a cases (6%). Seventeen type 1b cases were treated with PDI and 12 type 1b cases were treated with PDI combined with argon plasma coagulation (APC) or clipping. Re-bleeding occurred in five type 1b cases (17%) that resolved after additional endoscopic hemostasis in all cases. There was one adverse event from endoscopic treatment (1.6%).
  
  
  CONCLUSIONS
  Cardiovascular disease and liver cirrhosis were significant independent major predictors of small-bowel angioectasia. Type 1a angioectasias with oozing are indicated for PDI and type 1b angioectasias are indicated for PDI with APC or clipping.
authors: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. igawa@hiroshima-u.ac.jp.
authors: Atsushi
authors: A
authors: Igawa
authors: Department of Endoscopy, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. oka4683@hiroshima-u.ac.jp.
authors: Shiro
authors: S
authors: Oka
authors: Department of Endoscopy, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. colon@hiroshima-u.ac.jp.
authors: Shinji
authors: S
authors: Tanaka
authors: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. sayokok@hiroshima-u.ac.jp.
authors: Sayoko
authors: S
authors: Kunihara
authors: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. nakano0628@hiroshima-u.ac.jp.
authors: Makoto
authors: M
authors: Nakano
authors: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. aochin-blue@hiroshima-u.ac.jp.
authors: Taiki
authors: T
authors: Aoyama
authors: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. chayama@mba.ocn.ne.jp.
authors: Kazuaki
authors: K
authors: Chayama
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016888:Angiodysplasia / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D057908:Argon Plasma Coagulation; D053704:Capsule Endoscopy; D002318:Cardiovascular Diseases / Q000150:complications*; D058582:Double-Balloon Enteroscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000628:therapy*; D007421:Intestine, Small / Q000098:blood supply*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols