Clinical Outcome Of 41 Patients With Angiodysplasias Of The Small Intestine Visualized By Capsule Endoscopy: 11 Months Follow Up

Small intestine angiodysplasia is the most common cause of unexplained digestive bleeding visualized by capsule endoscopy. The clinical relevance and evolution of this pathology is poorly evaluated. Methods: From April 2002 to March 2004, 140 capsule examinations were performed for digestive bleeding unexplained after gastroscopy and colonoscopy, with a positive finding in 84 patients (60%) of whom 41 had angiodysplasias (49% of positive findings). They were 25 females and 16 males, median age 70 years old, with overt bleeding in 16 cases and occult anemia in 25. Median hemoglobin (Hb) was 7 g, 66% of patients had transfusion, 41% took NSAID or anticoagulant drugs. There were multiple angiodysplasias in 68% of patients.Localization was stomach (1), jejunum (25), ileum (6), and diffuse (9). Patients and (or) their doctors where contacted by phone to know the final diagnosis and the evolution of bleeding at the end of follow-up. Results: Median follow-up is 11 months (22-3). Another pathology is considered as the cause of bleeding in 5 cases: therefore, the accuracy of angiodysplasias as the cause of bleeding is 87%. A group of 13 patients received a specific treatment (9 therapeutic enteroscopies, 2 surgeries, and 2 interruptions of anticoagulant drugs): 11 are free of symptomatic bleeding with Hb > 10 g at the end of follow-up. Another group of 23 patients with angiodysplasias considered as the cause of bleeding received only iron supplementation and were observed: 18 are free of symptomatic bleeding with Hb > 10 g and 5 relapsed of whom 3 required transfusion. Neither age, Hb level, clinical presentation, number or localization of lesions were statisticaly predictive of decision to treat or observation, despite a tendency of more treatments in case of single lesion (46% vs 26%) or jejunal localization (70% vs 52%). 80% of patients are free of symptomatic bleeding with HB > 10 g at the end of follow-up. 4 patients died, all unrelated to digestive illness. Conclusion: After a 11 months follow-up, prognosis of small intestine angiodysplasias appears quite good, with 80% of patients free of symptomatic bleeding. A decison of simple observation with iron supplementation in 68% of angiodysplasias considered as the only cause of bleeding seems reasonable, with aggressive treatments proposed for severe or relapsing bleedings.