SMALL BOWEL ANGIOECTASIA ARE A MARKER OF FRAILTY AND CARRY A POOR PROGNOSIS

Aims This study aims to establish the 5-year survival of those diagnosed with bleeding small bowel (SB) angioectasia, with the hypothesis that many will suffer deaths relating to comorbidity rather than GI bleeding.

Methods SB capsule endoscopy (SBCE) procedures, performed for suspected SB bleeding or iron deficiency anaemia, with angioectasia isolated as the cause of SB bleeding and at least 5 years of follow up data were isolated (n=125) along with an age matched group with “normal” SBCE procedures (n=125). These were retrospectively analysed with further information on mortality and comorbidity gathered through hospital records.

Results Those with angioectasia had a median age of 72.7 years and comorbidities were common. The 5-year survival was 64.0% (80/125) compared to 70.4% (88/125) in those with “normal” SBCE. Those with significant cardiac or vascular comorbidity had a poorer survival (52.9% (37/70) at 5 years) but anticoagulation/antiplatelets seemed to make little difference.

37/125 (29.6%) were planned for endoscopic therapy, this group had a survival of 62.3% (23/37).

In those with SB bleeding secondary to angioectasia none of the subsequent deaths were directly attributable to gastrointestinal bleeding.

Conclusions The overall 5-year survival in those diagnosed with angioectasia on VCE was poor at 64.0% due to those diagnosed frequently being older and comorbid. This is comparable with the 5 year mortality seen when SB adenocarcinoma (all SEER stages combined) is diagnosed (68%) and worse than when the cancer is localised (85% survival at 5 years)(1).

This would support the hypothesis that a diagnosis of small bowel (SB) bleeding secondary to angioectasia suggests frailty.

(1) Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ CK. Cancer Statistics Review, 1975-2015 - SEER Statistics. SEER Cancer Stat Rev. 2017;