Angiodysplasia and bleeding in the small intestine treated by balloon-assisted enteroscopy

This study aimed to evaluate the outcomes in patients undergoing balloon-assisted enteroscopy (BAE) with heat probe or argon plasma coagulation and to identify risk factors for recurrent bleeding.

Data of the patients who were consecutively referred to our institution with angiodysplastic bleeding of the small intestine between August 2005 and February 2010 were reviewed. These 39 patients underwent BAE and were followed up for 6 months.

In all, 31 patients had melena and 8 had hematochezia. On BAE, 26 patients received endoscopic therapy, 3 underwent surgical intervention due to endoscopic therapy failure, and 10 underwent observation because a definite source of bleeding was not identified. Ten patients (25.6%) had recurrent bleeding during follow-up, including eight patients in the endoscopic therapy group and two in the observation group. Higher rates of recurrent bleeding were observed in association with the presence of melena initially (P = 0.028), but there were no significant differences in the rate of recurrence between patients who did and did not receive endoscopic therapy (P = 0.470). Age greater than 65 years (P = 0.058) and jejunal bleeding (P = 0.050) tended to increase the risk of recurrent bleeding compared with other factors.

BAE may be a beneficial approach to treat angiodysplastic bleeding in the small intestine. Elderly patients and those with melena or jejunal bleeding should be closely monitored for recurrent bleeding.