Nishimura Naoyuki, Mizuno Motowo, Shimodate Yuichi, Doi Akira, Mouri Hirokazu, Matsueda Kazuhiro, Yamamoto Hiroshi
Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
Int J Colorectal Dis. 2016 Dec;31(12):1869-1873. doi: 10.1007/s00384-016-2651-1. Epub 2016 Sep 5.
Colonic angiodysplasia is an important cause of lower gastrointestinal bleeding in the elderly. Here, we investigated the risk factors for bleeding from colonic angiodysplasia seen at endoscopy.
We conducted a retrospective case-control study by reviewing records of 435 patients with angiodysplasia at colonoscopy from November 2006 to November 2015 in our hospital. To identify risk factors for active bleeding, the following were analyzed: age, sex, comorbidities, use of antithrombotic drugs and non-steroidal anti-inflammatory drugs, and the size and location of the lesions.
Among the 435 patients, active bleeding from angiodysplasia was observed at endoscopy in 29 patients (6.7 %). Using multivariate analysis, we identified advanced age (odds ratio 5.15, 95 % confidence interval, 1.61-16.5), comorbidity of heart disease (6.88, 1.04-45.5), use of anticoagulant drug (4.22, 1.21-14.7), multiple lesions (6.67, 1.77-25.2), and small lesions (≤5 mm) (17.7, 4.90-64.0) as independent and significant risk factors for active bleeding. Actively bleeding colonic angiodysplasia lesions were very small in most cases (1-2 mm, 24/29, 83 %) and predominantly located in the right-side colon (26/29, 90 %). All of the 29 patients with active bleeding were successfully and safely treated endoscopically, but re-bleeding occurred in nine patients (31 %, 9/29) during the follow-up period of 2-84 months.
Multiple and small colonic angiodysplasia lesions in patients of advanced age, with heart disease, or receiving anticoagulants have increased risk for bleeding. We should be aware that small colonic angiodysplasia lesions in the right-side colon at colonoscopy in these patients may be a source of bleeding.
结肠血管发育异常是老年人下消化道出血的重要原因。在此，我们调查了内镜检查时结肠血管发育异常出血的危险因素。
我们通过回顾2006年11月至2015年11月我院435例结肠镜检查发现血管发育异常患者的记录，进行了一项回顾性病例对照研究。为确定活动性出血的危险因素，分析了以下因素：年龄、性别、合并症、抗血栓药物和非甾体抗炎药的使用情况，以及病变的大小和位置。
435例患者中，29例（6.7%）在内镜检查时发现血管发育异常活动性出血。通过多因素分析，我们确定高龄（比值比5.15，95%置信区间，1.61 - 16.5）、心脏病合并症（6.88，1.04 - 45.5）、抗凝药物使用（4.22，1.21 - 14.7）、多发病变（6.67，1.77 - 25.2）和小病变（≤5毫米）（17.7，4.90 - 64.0）是活动性出血的独立且显著的危险因素。活动性出血的结肠血管发育异常病变在大多数情况下非常小（1 - 2毫米，24/29，83%），且主要位于右侧结肠（26/29，90%）。29例活动性出血患者均成功且安全地接受了内镜治疗，但在2至84个月的随访期内，9例患者（31%，9/29）再次出血。
高龄、患有心脏病或接受抗凝治疗的患者出现多发和小的结肠血管发育异常病变时出血风险增加。我们应该意识到，在这些患者的结肠镜检查中，右侧结肠的小结肠血管发育异常病变可能是出血源。
