Repeat endotherapy for small-intestine vascular lesions

Satoshi Shinozaki, MD, PhD from Jichi Medical University and Shinozaki Medical Clinic in Tochigi, Japan discusses his Dr. ShinozakiOriginal Article “Favorable long-term outcomes of repeat endotherapy for small-intestine vascular lesions by double-balloon endoscopy.”

The focus of this study is to evaluate the long-term outcome of patients with small intestine vascular lesions (SIVLs) bleeding after repeat double-balloon endoscopy (DBE) endotherapy. We have previously reported on the long-term outcome of patients with obscure GI bleeding and have documented that patients with SIVLs had significantly lower rate of obscure GI bleeding control than did those with other lesions of the small intestine. This study demonstrated the effectiveness of repeat DBE endotherapy can improve the long-term outcome of patients with refractory bleeding secondary to SIVLs.

There had been misconstrued interpretation that DBE endotherapy might be ineffective for the management of SIVL bleeding because of their high rebleeding rate after the initial DBE endotherapy. We thought that it was necessary to elucidate the clinical impact of repeat DBE endotherapy on refractory SIVL bleeding through the long-term follow-up.

It has been known that a rebleeding rate after the DBE endotherapy of SIVL bleeding was high. This long-term (about 5 years) cohort study revealed that the patients who underwent repeat DBE endotherapy at the time of rebleeding showed significantly better outcome than those without repeat DBE endotherapy (mean (SD) 0.12 (0.19) versus 0.52 (0.33) times per year per patient (P < .006). Our assessment of the clinical impact of DBE endotherapy on mid-GI bleeding secondary to SIVLs demonstrates that perseverance with repeat DBE endotherapy in cases of refractory SIVL bleeding improves long-term outcome for these patients. Further to the findings of our study, we propose that a revised algorithm may recommend consideration of repeat DBE endotherapy in cases of rebleeding after initial DBE endotherapy caused by SIVLs.

Table 3Read the abstract for this article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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