Characteristics and outcomes of small-bowel vascular lesions and nonvascular lesions in patients with suspected small-bowel bleeding detected by deep enteroscopy: a single-center experience in Taiwan

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BACKGROUND: Small-bowel vascular lesions are a major cause of suspected small-bowel bleeding (SSBB), which poses considerable challenges in clinical practice. Hence, this study aimed to identify the clinical characteristics, management, and comparison between small bowel vascular and nonvascular lesions in patients with SSBB who underwent deep enteroscopy. METHODS: Between September 2009 and December 2023, 385 patients underwent single-balloon enteroscopy (SBE; a total of 592 procedures) at Tri-Service General Hospital. Among them, 203 patients with SSBB who underwent SBE (308 procedures) were enrolled. The clinical characteristics and endoscopy findings of small bowel vascular and nonvascular lesions were collected, and multiple variables were analyzed to determine the factors associated with lesion type and to evaluate clinical outcomes. RESULTS: Among patients with SSBB who underwent SBE, the lesion detection rate was 79% (161 patients). In patients with positive findings, vascular and nonvascular lesions were found in 39.1% and 60.9% of the patients, respectively. The most common etiologies of vascular and nonvascular lesions were angioectasia (88.89%) and ulcers (30.6%). Among the 63 patients with vascular lesions, angioectasia was the most common subtype, identified in 56 patients (88.89%), followed by Dieulafoy's lesion and lymphangioectasia (each 3.17%), and arteriovenous malformation, hemangioma, and varices (each 1.59%). Nonvascular lesions were more heterogeneous, with ulcers being the most common (30.61%), followed by diverticula (27.55%), active bleeding without identified source (15.31%), malignancy (10.20%), and inflammatory bowel disease (6.12%), among others. Among patients with end-stage renal disease (ESRD), those undergoing dialysis, or those using anticoagulant medications, vascular lesions were significantly more common than nonvascular lesions. APC was the most frequently used enteroscopic treatment in the vascular lesion group, whereas surgical intervention was more frequently performed in the nonvascular lesion group. CONCLUSION: In our study, angioectasia was the most common vascular lesion etiology in patients with SSBB. ESRD is independently associated with vascular lesion type among patients with SSBB and positive enteroscopic findings, and patients undergoing dialysis may represent a population with a higher likelihood of harboring vascular lesions. In conclusion, most vascular lesions in patients with SSBB can be successfully diagnosed and managed using deep enteroscopy. However, surgical or other interventional treatments may still be required in selected patients, particularly those with tumors, refractory bleeding, or lesions not amenable to enteroscopic therapy.

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