Davie Matt, Yung Diana E, Douglas Sarah, Plevris John N, Koulaouzidis Anastasios
a The University of Edinburgh , Edinburgh , UK.
b Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh , Edinburgh , UK.
Scand J Gastroenterol. 2019 May;54(5):597-602. doi: 10.1080/00365521.2019.1608293. Epub 2019 May 5.
Angioectasias are a prominent cause of small bowel (SB) bleeding frequently identified during capsule endoscopy (CE). Subsequent management depends upon grade/severity and location. There is increasing evidence that the location of SB angioectasias is not random. We aimed to map the distribution of SB angioectasias, and assess whether this impacted clinical outcomes. 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 was collected. Clinically significant angioectasias (P1/P2) and active SB bleeding were analysed further. Outcomes of patients with P2 angioectasias or active SB bleeding were recorded. 164 SBCE examinations reported angioectasias. 554 P1-2 angioectasias and active bleeds were seen, 435 (78.52%) 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 bleed were referred for intervention. Of initial interventions, 24 patients underwent upper GI endoscopy; 13 underwent double balloon enteroscopy (DBE). 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 15.6% of SBTT, compared with 7.9% in those who did not re-represent ( = 0.344). Patients who re-presented had an average 1.6 additional P1 angioectasias, compared with 7.6 amongst those who did not return ( = 0.017). Clinically significant angioectasias are overwhelmingly located within the proximal SB. The majority are within reach of conventional endoscopy. However, AEs are often multiple and many patients re-present following intervention.
血管扩张是小肠（SB）出血的一个主要原因，在胶囊内镜检查（CE）期间经常被发现。后续的治疗取决于分级/严重程度和位置。越来越多的证据表明，小肠血管扩张的位置并非随机分布。我们旨在绘制小肠血管扩张的分布图，并评估这是否会影响临床结果。对一家三级转诊中心在10年期间进行的胶囊内镜检查进行回顾性研究。收集有关小肠血管扩张的数量、位置和索林分类（P0 - 2）的信息。对具有临床意义的血管扩张（P1/P2）和活动性小肠出血进行进一步分析。记录患有P2级血管扩张或活动性小肠出血患者的结果。164例小肠胶囊内镜检查报告了血管扩张。共发现554处P1 - 2级血管扩张和活动性出血，其中435处（78.52%）位于小肠转运时间（SBTT）的第一个三分位数范围内。277处（50%）血管扩张在小肠转运时间的前10%内被发现。40/75（53.3%）患有一处以上P2级血管扩张和/或活动性出血的患者被转诊进行干预。在最初的干预措施中，24例患者接受了上消化道内镜检查；13例接受了双气囊小肠镜检查（DBE）。9/37（24.3%）在内镜检查中未发现可识别的血管扩张。在接受消融治疗的患者中，20/28（71.4%）再次出现缺铁性贫血或出血。在这组患者中，血管扩张的平均位置为小肠转运时间的15.6%，而未再次出现症状的患者中这一比例为7.9%（P = 0.344）。再次出现症状的患者平均多有1.6处额外的P1级血管扩张，而未复发的患者中有7.6处（P = 0.017）。具有临床意义的血管扩张绝大多数位于小肠近端。大多数都在传统内镜检查的范围内。然而，血管扩张通常是多发的，许多患者在干预后会再次出现症状。
