Endoscopy 2018; 50(04): S101-S102
DOI: 10.1055/s-0038-1637329
ESGE Days 2018 ePoster Podium presentations
20.04.2018 – Capsule 1
Georg Thieme Verlag KG Stuttgart · New York

ROLE OF WIRELESS CAPSULE ENDOSCOPY IN THE DIAGNOSIS OF OBSCURE GASTROINTESTINAL BLEEDING IN VON WILLEBRAND DISEASE: A RETROSPECTIVE CASE SERIES

F Francesca
1   Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
,
F Branchi
1   Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
,
S Orlando
1   Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
,
SM Siboni
2   Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
,
E Biguzzi
2   Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
,
M Vecchi
1   Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
,
L Elli
3   Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Center for Prevention and Diagnosis of Celiac Disease, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Von Willebrand disease (VWD) is the most common inherited bleeding disorder characterized by deficiency/dysfunction of von Willebrand factor. Recurrent gastrointestinal bleeding is a severe manifestation, however the diagnostic and therapeutic approach in obscure bleeding is not standardized. In particular, the role of capsule endoscopy (CE) needs further validation.

Methods:

Among 675 VWD patients followed at the A.B. Bonomi Hemophilia and Thrombosis Center, we retrospectively collected data about patients experiencing obscure recurrent GI bleeding referred to our Gastroenterology and Endoscopy Unit for small bowel evaluation between January 2010 and September 2017. Demographic data, VWD natural history, diagnostic tests, treatment and clinical follow-up were collected.

Results:

Between 2010 and 2017, 6 patients (3F, mean age 66 ± 13 years) affected by congenital VWD underwent capsule endoscopy for obscure gastrointestinal bleeding. They were affected by type 1 VWD (2 patients), type 2A (2), type 2B (1), type 3 (1). Overall, 9 procedures were performed. Seven positive findings were detected: small bowel angiodysplasia (3 patients, 1 with active bleeding), bright red blood in small bowel lumen (2) and in stomach (2). Anterograde double-balloon enteroscopy was performed to successfully treat the active bleeding with argon plasma coagulation and clipping. The other patients were conservatively managed with VWF/FVIII concentrate, tranexamic acid and blood transfusions. Surgical resection and second-line treatment such as hormonal therapy or thalidomide were not necessary. In 2 cases, secondary long-term prophylaxis with VFW/FVIII concentrates was started to prevent new bleeding episodes.

Conclusions:

Obscure gastrointestinal bleeding is a challenging complication in VWD. Endoscopic procedures such as capsule endoscopy and double balloon enteroscopy is a successful and well-tolerated tool to diagnose and manage small bowel bleeding. However, the efficacy highly depends on the timing of procedure and presence of active bleeding. A positive finding can crucially modify the management of the patient. To date, a multimodal approach is recommended.