Endoscopy 2019; 51(04): S10
DOI: 10.1055/s-0039-1681199
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: Capsule 1 Club B
Georg Thieme Verlag KG Stuttgart · New York

MAPPING THE DISTRIBUTION OF SMALL BOWEL ANGIOECTASIAS

M Davie
1   University of Edinburgh, Edinburgh, United Kingdom
,
D Yung
2   The Royal Infirmary of Edinburgh, Endoscopy Unit, Edinburgh, United Kingdom
,
J Plevris
2   The Royal Infirmary of Edinburgh, Endoscopy Unit, Edinburgh, United Kingdom
,
A Koulaouzidis
2   The Royal Infirmary of Edinburgh, Endoscopy Unit, Edinburgh, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Angioectasias are the main cause of small bowel (SB) bleeding. They are frequently identified during capsule endoscopy (CE). Subsequent management depends upon severity/extent and location. There is mounting evidence that the location of SB angioectasias is not entirely random. We aimed to map the distribution and size of SB angioectasias, and assess whether this impacted clinical outcomes significantly.

Methods:

Retrospective study examining CEs performed over a 10-year period at a tertiary referral centre. Information regarding number, location, and Saurin classification (P0 – 2) of SB angioectasias were collected. Clinically significant angioectasias (P1/P2) and active SB bleeding were analysed. Clinical outcomes in patients with P2 angioectasia or active SB bleeding were recorded.

Results:

164 SBCE examinations in our cohort reported angioectasias. 554 P1 – 2 angioectasias and areas of active bleeding were seen, 435 (78.52%) of these within the first tertile of SB transit time (SBTT). 277 (50%) angioectasias were identified within the first 10% of SBTT. 40/75 (53.3%) patients with > 1 P2 angioectasia and/or active bleeding were referred for intervention. Of the initial interventions, 24 patients underwent upper GI endoscopy; 13 underwent double balloon enteroscopy (DBE) (12 oral, 1 anal route). 9/37 (24.3%) had no identifiable angioectasias on endoscopy. Of those receiving ablative therapy, 20/28 (71.4%) re-presented with iron-deficiency anaemia or bleeding. In this group, average angioectasia position was within the first 15.6% of SBTT, compared with 7.9% in those who did not re-represent (p = 0.3442). Patients who re-presented had an average 1.6 additional P1 angioectasias, compared with 7.6 amongst those who did not return (p = 0.0173).

Conclusions:

Clinically significant angioecatasias are overwhelmingly located within the first 30% of SB. The majority are within reach of conventional endoscopy. However, AEs are often multiple and patients often re-present following intervention. In our cohort, additional P1 angioectasias in patients with P2 angioectasias/active bleeding were not associated with increased re-bleeding.