• Angioectasia
• Gastrointestinal bleeding
• Pharmacological
• Sirolimus
• Vascular anomalies

• Humans
• Sirolimus/therapeutic use
• Gastrointestinal Hemorrhage/drug therapy
• Gastrointestinal Hemorrhage/etiology
• Treatment Outcome
• Bibliometrics
• Angiodysplasia/drug therapy
• Angiodysplasia/complications
• Colonic Diseases/drug therapy
• Colonic Diseases/diagnosis
• Colon/blood supply
• Colon/pathology
• Colon/drug effects
• Colonoscopy

• colon
• gastrointestinal bleeding
• idiopathic thrombocytopenic purpura
• recombinant human vascular endostatin
• telangiectasia
• vascular endothelial growth factor

• Chronic kidney disease
• Gastrointestinal angiectasias
• Gastrointestinal bleeding

• Humans
• Male
• Female
• Case-Control Studies
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/epidemiology
• Aged
• Middle Aged
• Risk Factors
• Retrospective Studies
• Gastrointestinal Diseases/epidemiology
• Gastrointestinal Diseases/complications
• Gastrointestinal Diseases/etiology

• LVAD
• angiodysplasia
• angiogenesis
• gastrointestinal bleeding

• Humans
• Male
• Heart-Assist Devices/adverse effects
• Female
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Angiogenesis Inhibitors/therapeutic use
• Angiogenesis Inhibitors/adverse effects
• Angiogenesis Inhibitors/administration & dosage
• Aged
• Pyrimidines/therapeutic use
• Pyrimidines/adverse effects
• Bevacizumab/therapeutic use
• Bevacizumab/adverse effects
• Bevacizumab/administration & dosage
• Middle Aged
• Sulfonamides/therapeutic use
• Indazoles/adverse effects
• Indazoles/therapeutic use
• Retrospective Studies
• Treatment Outcome
• Angiogenesis

• Angiodysplasia
• Gastrointestinal
• Recurrent bleeding
• Refractory bleeding
• Small bowel
• Somatostatin analogues
• Thalidomide
• anti-Vascular Endothelial Growth Factor

• Cost effectiveness
• Double balloon enteroscopy
• Gastrointestinal bleeding
• Small bowel angioectasia
• Somatostatin analogues

• Humans
• Retrospective Studies
• Gastrointestinal Hemorrhage/therapy
• Gastrointestinal Hemorrhage/surgery
• Intestine, Small
• Vascular Diseases
• Dilatation, Pathologic

• Bleeding
• Capsule endoscopy
• Enteroscopy
• Mid-gut
• Small intestine
• Small-bowel

• Humans
• Intestine, Small/diagnostic imaging
• Intestine, Small/pathology
• Capsule Endoscopy
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Laparoscopy

• Endovascular
• Hereditary hemorrhagic telangiectasia
• Minimally-invasive
• Treatment

Small bowel angiodysplasia (SBAD) is reported to account for nearly 50% of cases of small bowel bleeding. When SBAD occurs frequently, it is difficult to treat all the angiodysplasias endoscopically, and gastrointestinal bleeding often recurs. Hormone therapy, somatostatin analogs, thalidomide and vascular endothelial growth factor (VEGF)-neutralizing antibodies have been reported to reduce gastrointestinal angiodysplasia (GIAD) bleeding. However, there is no strong evidence to recommend them. Also, there are no guidelines for their use. Hereditary hemorrhagic telangiectasia (HHT) is a hereditary disease caused by abnormalities in VEGF, resulting in multiple GIADs. A treatment guideline has been created for GIAD in HHT, and the use of tranexamic acid, an antifibrinolytic agent, is the first recommendation pharmacotherapy for GIAD with gastrointestinal bleeding that is difficult to treat endoscopically. It has been reported that fibrinolysis is accelerated in GIAD patients who are not HHT, similar to HHT patients. The use of tranexamic acid for gastric antral vascular ectasia in GIAD has been reported to be useful. However, there are very few reports of its use for SBAD. There are concerns with tranexamic acid use regarding the development of thrombosis/embolism, but there are few reports of such side effects. Future clinical trials including tranexamic acid for SBAD are desired.

• Angiodysplasia
• Intestine
• Hereditary hemorrhagic telangiectasia
• Tranexamic acid
• Endoscopic treatment
• Pharmacotherapy

• Humans
• Tranexamic Acid/adverse effects
• Vascular Endothelial Growth Factor A
• Gastrointestinal Hemorrhage/drug therapy
• Gastrointestinal Hemorrhage/etiology
• Colonic Diseases
• Angiodysplasia/complications
• Angiodysplasia/diagnosis
• Angiodysplasia/drug therapy
• Telangiectasia, Hereditary Hemorrhagic/complications
• Telangiectasia, Hereditary Hemorrhagic/drug therapy

• GI bleed management in CF-LVADs
• arteriovenous malformations
• continuous-flow left ventricular assist devices
• gastrointestinal bleeds
• octreotide

• gastrointestinal bleeding
• perioperative period
• tavr

• Humans
• Aged
• Transcatheter Aortic Valve Replacement/adverse effects
• Gastrointestinal Hemorrhage/epidemiology
• Gastrointestinal Hemorrhage/etiology
• Heart Valve Diseases

• Autoimmune gastritis
• Crohn’s disease
• celiac disease
• gastrointestinal bleeding
• iron
• ulcerative colitis

• Device assisted enteroscopy
• Iron deficiency Anemia (IDA)
• Iron therapy
• Obscure gastrointestinal bleeding
• Occult gastrointestinal bleeding
• Video capsule endoscopy

• Anemia, Iron-Deficiency/diagnosis
• Anemia, Iron-Deficiency/etiology
• Anemia, Iron-Deficiency/therapy
• Capsule Endoscopy
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Intestine, Small

• Autosomal dominant polycystic kidney disease
• Diverticular bleeding
• Diverticulitis
• Diverticulosis
• Nationwide Inpatient Sample

Left ventricular assist devices (LVAD) are increasingly become common as life prolonging therapy in patients with advanced heart failure. Current devices are now used as definitive treatment in some patients given the improved durability of continuous flow pumps. Unfortunately, continuous flow LVADs are fraught with complications such as gastrointestinal (GI) bleeding that are primarily attributed to the formation of arteriovenous malformations. With frequent GI bleeding, antiplatelet and anticoagulation therapies are usually discontinued increasing the risk of life-threatening events. Small bowel bleeds account for 15% as the source and patients often undergo multiple endoscopic procedures. Treatment strategies include resuscitative measures and endoscopic therapies. Medical treatment is with octreotide. Novel treatment options include thalidomide, angiotensin converting enzyme inhibitors/angiotensin II receptor blockers, estrogen-based hormonal therapies, doxycycline, desmopressin and bevacizumab. Current research has explored the mechanism of frequent GI bleeds in this population, including destruction of von Willebrand factor, upregulation of tissue factor, vascular endothelial growth factor, tumor necrosis factor-α, tumor growth factor-β, and angiopoetin-2, and downregulation of angiopoetin-1. In addition, healthcare resource utilization is only increasing in this patient population with higher admissions, readmissions, blood product utilization, and endoscopy. While some of the novel endoscopic and medical therapies for LVAD bleeds are still in their development stages, these tools will yet be crucial as the number of LVAD placements will likely only increase in the coming years.

• Left ventricular assist device
• Push enteroscopy
• Double balloon enteroscopy
• Video capsule endoscopy
• Octreotide
• Bevacizumab
• Gastrointestinal bleeding

• Angiogenesis Inhibitors/therapeutic use
• Angiotensin-Converting Enzyme Inhibitors/therapeutic use
• Arteriovenous Malformations/etiology
• Arteriovenous Malformations/therapy
• Endoscopy, Gastrointestinal/methods
• Gastrointestinal Agents/therapeutic use
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Heart Failure/surgery
• Heart-Assist Devices/adverse effects
• Humans

• Diagnosis
• Gastrointestinal bleeding
• Small intestine
• Treatment
• Video capsule endoscopy

• Adult
• Aged
• Capsule Endoscopy/methods
• Diagnosis, Differential
• Female
• Gastrointestinal Hemorrhage/complications
• Gastrointestinal Hemorrhage/diagnosis
• Humans
• Intestinal Diseases/complications
• Intestinal Diseases/diagnosis
• Intestine, Small/diagnostic imaging
• Male
• Melena/diagnosis
• Melena/etiology
• Middle Aged

• APC, argon plasma coagulation
• GIAD, GI angiodysplasia
• LVAD, left ventricular assist device
• RFA, radiofrequency ablation
• SBA, small-bowel angiodysplasia
• SBRFA, small-bowel radiofrequency ablation

Isolated gastrointestinal venous malformations (GIVMs) are extremely rare congenital developmental abnormalities of the venous vasculature. Because of their asymptomatic nature, the diagnosis is often quite challenging. However, as symptomatic GIVMs have nonspecific clinical manifestations, misdiagnosis is very common. Here, we report a case of isolated diffuse GIVMs inducing mechanical intestinal obstruction. A literature review was also conducted to summarize clinical features, diagnostic points, treatment selections and differential diagnosis in order that doctors may have a comprehensive understanding of this disease.

A 50-year-old man presented with recurrent painless gastrointestinal bleeding for two months and failure to pass flatus and defecate with nausea and vomiting for ten days. Digital rectal examination found bright red blood and soft nodular masses 3 cm above the anal verge. Computed tomography showed that part of the descending colon and rectosigmoid colon was thickened with phleboliths in the intestinal wall. Colonoscopy exhibited bluish and reddish multinodular submucosal masses and flat submucosal serpentine vessels. Endoscopic ultrasonography showed anechoic cystic spaces within intestinal wall. The lesions were initially thought to be isolated VMs involving part of the descending colon and rectosigmoid colon. Laparoscopic subtotal proctocolectomy, pull-through transection and coloanal anastomosis and ileostomy were performed. Histopathology revealed intact mucosa and dilated, thin-walled blood vessels in the submucosa, muscularis, and serosa involving the entire colorectum. The patient recovered with complete symptomatic relief during the 52-mo follow-up period.

The diagnosis of isolated GIVMs is challenging. The information presented here is significant for the diagnosis and management of symptoms.

• Case report
• Isolated gastrointestinal venous malformations
• Mechanical intestinal obstruction
• Pull-through transection and coloanal anastomosis
• Diagnosis
• Treatment

Small bowel vascular lesions, including angioectasia (AE), Dieulafoy’s lesion (DL) and arteriovenous malformation (AVM), are the most common causes of obscure gastrointestinal bleeding. Since AE are considered to be venous lesions, they usually manifest as a chronic, well-compensated condition. Subsequent to video capsule endoscopy, deep enteroscopy can be applied to control active bleeding or to improve anemia necessitating blood transfusion. Despite the initial treatment efficacy of argon plasma coagulation (APC), many patients experience re-bleeding, probably because of recurrent or missed AEs. Pharmacological treatments can be considered for patients who have not responded well to other types of treatment or in whom endoscopy is contraindicated. Meanwhile, a conservative approach with iron supplementation remains an option for patients with mild anemia. DL and AVM are considered to be arterial lesions; therefore, these lesions frequently cause acute life-threatening hemorrhage. Mechanical hemostasis using endoclips is recommended to treat DLs, considering the high re-bleeding rate after primary APC cauterization. Meanwhile, most small bowel AVMs are large and susceptible to re-bleeding therefore, they usually require surgical resection. To achieve optimal diagnostic and therapeutic approaches for each type of small bowel lesion, the differences in their epidemiology, pathology and clinical presentation must be understood.

• Angiodysplasia
• Angioectasia
• Dieulafoy’s lesion
• Arteriovenous malformation
• Obscure gastrointestinal bleeding
• Video capsule endoscopy
• Deep enteroscopy
• Argon plasm coagulation

• Anemia/diagnosis
• Anemia/etiology
• Anemia/therapy
• Angiodysplasia/complications
• Angiodysplasia/diagnosis
• Angiodysplasia/therapy
• Argon Plasma Coagulation
• Capsule Endoscopy
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Hemostatic Techniques
• Humans
• Intestine, Small/blood supply
• Intestine, Small/diagnostic imaging
• Iron/administration & dosage
• Treatment Outcome

Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes; nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient’s quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.

• Angiodysplasias
• Angioectasias
• Vascular malformations
• Epidemiology
• Pathogenesis
• Endoscopic treatment
• Somatostatin analogues

• Anemia, Iron-Deficiency/diagnosis
• Anemia, Iron-Deficiency/etiology
• Anemia, Iron-Deficiency/therapy
• Angiodysplasia/complications
• Angiodysplasia/diagnosis
• Angiodysplasia/therapy
• Blood Transfusion
• Capsule Endoscopy
• Endoscopy, Gastrointestinal/methods
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Hemostatic Techniques
• Hemostatics/administration & dosage
• Humans
• Intestine, Small/blood supply
• Intestine, Small/diagnostic imaging
• Iron/administration & dosage
• Risk Factors
• Secondary Prevention/methods
• Treatment Outcome

Recurrent obscure gastrointestinal bleeding amongst patients with chronic kidney disease is a challenging problem gastroenterologists are facing and is associated with an extensive diagnostic workup, limited therapeutic options, and high healthcare costs. Small-bowel angiodysplasia is the most common etiology of obscure and recurrent gastrointestinal bleeding in the general population. Chronic kidney disease is associated with a higher risk of gastrointestinal bleeding and of developing angiodysplasia compared with the general population. As a result, recurrent bleeding in this subgroup of patients is more prevalent and is associated with an increased number of endoscopic and radiographic procedures with uncertain benefit. Alternative medical therapies can reduce re-bleeding; however, more studies are needed to confirm their efficacy in this subgroup of patients.

• Obscure gastrointestinal bleeding
• angiodysplasia
• arteriovenous malformations
• chronic kidney disease
• small-bowel bleeding

• Abnormal vessels
• Gastrointestinal bleeding
• Telangiectasia
• Vascular abnormalities

• Angiodysplasia
• Gastrointestinal bleeding
• Hormonal therapy
• Somatostatin analogues
• Thalidomide

• Angiodysplasia/complications
• Gastrointestinal Hemorrhage/drug therapy
• Humans
• Italy
• Practice Guidelines as Topic
• Progesterone/therapeutic use
• Quality of Life
• Randomized Controlled Trials as Topic
• Societies, Medical
• Somatostatin/analogs & derivatives
• Somatostatin/therapeutic use
• Thalidomide/therapeutic use
• Treatment Outcome

• gastrointestinal bleeding
• thalidomide

• GIADs bleeding
• angiodysplasia
• somatostatin analog

• Argon plasma coagulation
• capsule endoscopy
• double balloon enteroscopy
• serum biomarkers
• small bowel angioectasias
• somatostatin analogues
• thalidomide

• Angiodysplasias
• Arteriovenous malformations
• Atrial fibrillation
• Left Atrial Appendage
• Octreotide

• Angiodysplasias
• Bevacizumab
• Gastrointestinal bleeding
• Hereditary hemorrhagic telangiectasia
• Rendu-Osler-Weber disease
• Telangiectasias

• Lanreotide
• argon plasma coagulation
• bleeding episodes
• double balloon enteroscopies
• haemoglobin
• packed red cells
• small bowel angioectasias
• somatostatin analogues
• transfusion

• Diffuse angiodysplasias
• Gastrointestinal cancer
• Iron-deficiency anemia
• Occult blood loss
• Quick diagnosis units

• Aged
• Aged, 80 and over
• Anemia, Iron-Deficiency/epidemiology
• Anemia, Iron-Deficiency/etiology
• Angiodysplasia/complications
• Angiodysplasia/diagnosis
• Endoscopy, Digestive System
• Female
• Follow-Up Studies
• Gastrointestinal Diseases/complications
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Tract/pathology
• Hemoglobins/analysis
• Humans
• Male
• Middle Aged
• Occult Blood
• Prospective Studies
• Spain

The prevalence of diverticulosis is increasing with 5-10% of patients developing diverticulitis and 5-15% developing symptomatic bleeding. Diverticulitis can result in abscess, perforation, fistula, or obstruction. Bleeding has combined morbidity and mortality rates of 10-20%. The purpose of this study was to compare diverticulitis-related complications and transfusion requirements for diverticular bleeding in patients with normal to moderately reduced kidney function (glomerular filtration rate (GFR) ≥ 30 mL/min/1.73 m²) and patients with severe renal impairment (GFR < 30 mL/min/1.73 m²), and identify factors associated with these outcomes.

We retrospectively reviewed records of all patients with diverticulitis and diverticular bleeding treated at our hospital from January 1, 2011 to July 31, 2016. Patients were evaluated for baseline characteristics, GFR, baseline hemoglobin, medications, comorbidities, length of stay (LOS), presence of perforations or abscesses and the need for transfusion.

Of the 291 patients included, males were 167 (58%). Perforations and abscesses complicating diverticulitis developed in 31/136 (23%) of patients with GFR ≥ 30 mL/min/1.73 m², and in 13/26 (50%) of patients with GFR < 30 mL/min/1.73 m² (odds ratio (OR): 3.4; 95% confidence interval (CI): 1.423 - 8.06; P = 0.0073). Mean LOS (days) was 6.3 ± 4 in the GFR ≥ 30 mL/min/1.73 m² group and 8.5 ± 4.4 in GFR < 30 mL/min/1.73 m² group (P = 0.0001). Blood transfusion for diverticular bleeding occurred in 11/78 (14%) of patients with GFR ≥ 30 mL/min/1.73 m² and in 22/51 (43%) of patients with GFR < 30 mL/min/1.73 m² (OR: 4.6; 95% CI: 1.99 - 10.76; P = 0.0004). Among patients who needed transfusion, mean LOS was 8.5 ± 2.5 in GFR ≥ 30 mL/min/1.73 m² group and 9 ± 5 in those with GFR < 30 mL/min/1.73 m² (P = 0.04). There were no differences in age, gender or race between the study groups.

There was a significant increase in complicated diverticulitis cases, transfusion requirements for diverticular bleeding and LOS in patients with severely reduced kidney function compared to patients with normal-moderately reduced renal function.

• Bleeding
• Diverticulitis
• GFR
• Renal failure

To investigate the risk factors for re-bleeding events in patients with small intestinal vascular malformation and assess the influence of thalidomide on the re-bleeding rate.

This study involved patients with gastrointestinal bleeding referred to the First Affiliated Hospital of Zhengzhou University for capsule endoscopy (CE) and enteroscopy between January 2012 and December 2014. Only patients with small intestinal vascular malformation were included in the study. Follow-up data were obtained through medical records review, telephone interviews or follow-up clinic visits to identify the risk factors associated with re-bleeding. Based on the follow-up data, the re-bleeding rate was compared between patients who had been treated with thalidomide and those who had not.

A total of 156 patients were included in the study, and all of them completed the follow-up, with a mean follow-up duration of 10.78 ± 7.64 mo. Multiple regression analysis identified that presence of hypertension (HR = 1.994, 95%CI: 1.236-3.125, P = 0.005), multiple lesions (≥3) (HR = 1.644, 95%CI: 1.002-2.703, P = 0.049) and liver cirrhosis (HR = 2.116, 95%CI: 1.063-4.212, P = 0.033) were significant independent predictors of re-bleeding, while treatment with thalidomide was a protecting factor (HR = 0.497, 95%CI: 0.303-0.816, P = 0.006). The cumulative re-bleeding rates in patients who were treated with thalidomide and those who were not were 35.71% and 54.65%, respectively, and the difference reached statistical significance (P < 0.05).

The re-bleeding rate in patients with small bowel vascular malformation is relatively high, especially those with hypertension, multiple lesions (≥3) and liver cirrhosis. Repeated CE or enteroscopy is recommended for those patients with risk factors for re-bleeding within 2 years. Treatment with thalidomide for patients without contraindication can reduce the re-bleeding rate.

• Small intestinal vascular malformation
• Capsule endoscopy
• Enteroscopy
• Re-bleeding
• Thalidomide

• Angiodysplasia
• Argon Plasma Coagulation
• Endoscopy
• Octreotide
• Thalidomide

• Anemia, Iron-Deficiency/etiology
• Angiography
• Balloon Enteroscopy
• Capsule Endoscopy
• Colonoscopy
• Duodenal Diseases/diagnostic imaging
• Endoscopy, Gastrointestinal
• Gastrointestinal Hemorrhage/diagnostic imaging
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Ileal Diseases/diagnostic imaging
• Jejunal Diseases/diagnostic imaging
• Magnetic Resonance Imaging
• Tomography, X-Ray Computed

• Anti-angiogenic therapy
• Capsule endoscopy
• Deep enteroscopy
• Gastrointestinal angiodysplasia
• Rebleeding
• Vascular endothelial growth factor

• Angiography
• Deep enteroscopy
• Obscure GI bleeding
• Suspected small bowel hemorrhage
• Video capsule endoscopy

• Angiodysplasia
• Double-balloon endoscopy (DBE)
• Small intestine
• Transumbilical single-incision laparoscopic surgery (T-SILS)