Endoscopic treatment of small bowel hemangiomas via double-balloon enteroscopy: A single-center comparative study

Table 1 Clinical characteristics of the study patients, mean ± SD/n (%)

Characteristic		Results (n = 75)
Age, years		42.95 ± 19.90
Sex	Male	27 (36.00)
	Female	48 (64.00)
BMI		21.31 ± 3.34
History of blood transfusion		28 (37.3)
NSAID		1 (1.33)
Hypertension		14 (18.67)
Diabetes		3 (4.00)
Family history of hemangioma		0 (0)
Hepatitis		6 (8.0)
History of surgery and trauma		35 (46.67)
History of radiotherapy and chemotherapy		3 (4.00)
Abnormal coagulation		16 (21.33)
Albumin, g/L		39.09 ± 3.69
Hemoglobin, g/L		86.03 ± 21.15
Interventional therapy		62 (82.67)
Method of DBE insertion	Oral	43 (63.24)
	Anal	25 (36.76)
Length of operation, minutes		80.53 ± 27.83
Blood transfusion volume, mL		225.00 ± 440.82
Active bleeding		16 (21.33)
Lesion size, cm		0.99 ± 0.61
Number of lesions		3.62 ± 4.11
Location of lesions	Duodenum	4 (5.33)
	Upper jejunum	18 (24.00)
	Lower jejunum	10 (13.33)
	Upper ileum	22 (29.33)
	Lower ileum	21 (28.00)
Treatment methods	Conservative treatment	13 (17.33)
	Lauromacrogol injection	20 (26.67)
	Argon plasma coagulation therapy	22 (29.33)
	Ligation therapy	18 (24.00)
	Clip therapy	2 (2.67)
Bleeding recurrence		13 (17.33)

BMI: Body mass index; NSAID: Nonsteroidal anti-inflammatory drug; DBE: Double-balloon endoscopy.

Table 2 Comparison of conservative therapy and interventional therapy, mean ± SD/n (%)

		Conservative therapy (n = 13)	Interventional therapy (n = 62)	P value1	Ligation therapy (n = 18)	P value2	Lauromacrogol injection (n = 20)	P value3	Argon plasma coagulation therapy (n = 22)	P value4
Age, years		55.38 ± 12.29	40.34 ± 20.27	0.012	32.83 ± 8.73	0.001	25.00 ± 8.80	0.001	59.55 ± 19.30	0.491
Sex	Male	7 (53.85)	20 (32.26)	0.204	2 (11.11)	0.017	9 (55.00)	0.728	9 (40.91)	0.503
	Female	6 (46.15)	42 (67.74)		16 (88.89)		11 (55.00)		13 (59.09)
BMI		24.25 ± 3.56	20.70 ± 2.97	0.000	18.78 ± 1.71	0.001	20.74 ± 2.98	0.005	22.13 ± 3.12	0.075
History of blood transfusion		4 (30.77)	24 (38.71)	0.756	12 (66.67)	0.073	11 (55.00)	0.284	0 (0.00)	0.014
Antithrombotic		0 (0)	0 (0)	NA	0 (0.00)	NA	0 (0.00)	NA	0 (0.00)	NA
NSAID		0 (0.00)	1 (1.61)	1.000	0 (0.00)	1.000	0 (0.00)	1.000	1 (4.55)	1.000
Hypertension		6 (46.15)	8 (12.90)	0.012	2 (11.11)	0.043	0 (0.00)	0.002	6 (27.27)	0.292
Diabetes		1 (7.69)	2 (3.23)	0.440	0 (0.00)	0.419	0 (0.00)	0.394	2 (9.09)	1.000
Family history of hemangioma		0 (0)	0 (0)	NA	0 (0.00)	NA	0 (0.00)	NA	0 (0.00)	NA
Hepatitis		3 (23.08)	3 (4.84)	0.061	0 (0.00)	0.064	0 (0.00)	0.052	3 (13.64)	0.648
History of surgery and trauma		4 (30.77)	31 (50.00)	0.238	14 (77.78)	0.013	14 (70.00)	0.038	2 (9.09)	0.166
History of radiotherapy and chemotherapy		1 (7.69)	2 (3.23)	0.440	0 (0.00)	0.419	0 (0.00)	0.394	2 (9.09)	1.000
Abnormal coagulation		2 (15.38)	22 (35.48)	0.722	3 (16.67)	1.000	7 (35.00)	0.263	3 (13.64)	1.000
Albumin, g/L		38.25 ± 5.14	39.26 ± 3.37	0.396	41.06 ± 2.86	0.065	39.65 ± 2.60	0.313	37.64 ± 3.75	0.692
Hemoglobin, g/L		95.23 ± 28.28	84.10 ± 19.06	0.104	85.22 ± 15.43	0.215	90.25 ± 25.75	0.605	79.77 ± 12.18	0.031
Blood transfusion volume, mL		NA	232.26 ± 459.78	NA	200.00 ± 388.06	NA	310.00 ± 451.78	NA	163.64 ± 500.04	NA
Lesion size, cm		0.77 ± 0.88	1.01 ± 0.58	0.362	1.28 ± 0.35	0.046	1.44 ± 0.40	0.013	0.46 ± 0.37	0.202
Number of lesions		2.11 ± 1.27	3.84 ± 4.34	0.241	4.33 ± 5.09	0.213	5.05 ± 3.56	0.024	2.27 ± 4.10	0.909
Location of lesions	Duodenum	1 (7.69)	3 (4.84)	0.985	0 (0.00)	0.420	3 (15.00)	0.945	0 (0.00)	0.442
	Upper jejunum	3 (23.08)	15 (24.19)		3 (16.67)		5 (25.00)		6 (27.27)
	Lower jejunum	2 (15.38)	8 (12.90)		1 (5.56)		3 (15.00)		4 (18.18)
	Upper ileum	4 (30.77)	18 (29.03)		11 (61.11)		4 (20.00)		3 (13.64)
	Lower ileum	3 (23.08)	18 (29.03)		3 (16.67)		5 (25.00)		9 (40.91)
Bleeding recurrence		7 (53.85)	6 (9.68)	0.001	3 (16.67)	0.052	2 (10.00)	0.013	1 (4.55)	0.002

¹Comparing interventional therapy with conservative therapy.

²Comparing ligation therapy with conservative therapy.

³Comparing lauromacrogol injection with conservative therapy.

⁴Comparing argon plasma coagulation therapy with conservative therapy.

BMI: Body mass index; NSAID: Nonsteroidal anti-inflammatory drug; NA: Not available.

Table 3 Comparison of different interventional therapy, mean ± SD/n (%)

		Lauromacrogol injection (n = 20)	Ligation therapy (n = 18)	P value1	Argon plasma coagulation therapy (n = 22)	P value2
Age		25.00 ± 8.80	32.83 ± 8.73	0.009	59.55 ± 19.30	0.001
Sex	Male	9 (55.00)	2 (11.11)	0.033	9 (40.91)	0.055
	Female	11 (55.00)	16 (88.89)		13 (59.09)
BMI		20.74 ± 2.98	18.78 ± 1.71	0.019	22.13 ± 3.12	0.001
History of blood transfusion		11 (55.00)	12 (66.67)	0.522	0 (0.00)	0.001
Antithrombotic		0 (0.00)	0 (0.00)	NA	0 (0.00)	NA
NSAID		0 (0.00)	0 (0.00)	NA	1 (4.55)	0.415
Hypertension		0 (0.00)	2 (11.11)	0.218	6 (27.27)	0.032
Diabetes		0 (0.00)	0 (0.00)	NA	2 (9.09)	0.167
Family history of hemangioma		0 (0.00)	0 (0.00)	NA	0 (0.00)
Hepatitis		0 (0.00)	0 (0.00)	NA	3 (13.64)	0.065
History of surgery and trauma		14 (70.00)	14 (77.78)	0.719	2 (9.09)	0.001
History of radiotherapy and chemotherapy		0 (0.00)	0 (0.00)	NA	2 (9.09)	0.167
Abnormal coagulation		7 (35.00)	3 (16.67)	0.278	3 (13.64)	0.202
Albumin, g/L		39.65 ± 2.60	41.06 ± 2.86	0.121	37.64 ± 3.75	0.004
Hemoglobin, g/L		90.25 ± 25.75	85.22 ± 15.43	0.476	79.77 ± 12.18	0.199
Blood transfusion volume, mL		310.00 ± 451.78	200.00 ± 388.06		163.64 ± 500.04	0.610
Location of lesions	Duodenum	3 (15.00)	0 (0.00)	0.085	0 (0.00)	0.019
	Upper jejunum	5 (25.00)	3 (16.67)		6 (27.27)
	Lower jejunum	3 (15.00)	1 (5.56)		4 (18.18)
	Upper ileum	4 (20.00)	11 (61.11)		3 (13.64)
	Lower ileum	5 (25.00)	3 (16.67)		9 (40.91)
Lesion shape	Flat	0 (0.00)	0 (0.00)	NA	22 (100)	0.001
	Raised	20 (100)	18 (100)		0 (0.00)
Duration of endoscopic operation		79.75 ± 29.36	97.50 ± 26.69	0.060	66.14 ± 21.21	0.001
Bleeding due to endoscopic operation		3.00 (15.00)	8.00 (44.44)	0.046	2.00 (9.09)	0.018
Lesion size, cm		1.44 ± 0.40	1.28 ± 0.35	0.221	0.46 ± 0.37	< 0.001
Number of lesions		5.05 ± 3.56	4.33 ± 5.09	0.615	2.27 ± 4.10	0.098
Tech success		19.00 (95.00)	13.00 (72.22)	0.055	22.00 (100.00)	0.009
Clinical success		18.00 (90.00)	15.00 (83.33)	0.653	21.00 (95.45)	0.446
Adverse event	Fever	2.00 (9.09)	2.00 (9.09)	0.567	2.00 (9.09)	0.760
	Abdominal pain	1.00 (4.55)	1.00 (4.55)		1.00 (4.55)
	Bloating	1.00 (4.55)	1.00 (4.55)		1.00 (4.55)
	Ulcers	0.00 (0.00)	0.00 (0.00)		0.00 (0.00)

¹Comparing lauromacrogol injection with ligation therapy.

²Comparing lauromacrogol injection, ligation therapy, and argon plasma coagulation therapy.

BMI: Body mass index; NSAID: Nonsteroidal anti-inflammatory drug; NA: Not available.

Table 4 Comparison of recurrent bleeding and non-recurrent bleeding, mean ± SD/n (%)

		Non-recurring bleeding (n = 62)	Recurring bleeding (n = 13)	P value
Age		43.79 ± 19.79	38.92 ± 20.73	0.426
BMI		21.24 ± 3.17	21.64 ± 4.17	0.698
Sex	Male	19 (30.65)	8 (61.54)	0.055
	Female	43 (69.35)	5 (38.46)
History of blood transfusion		23 (37.10)	5 (38.46)	1.000
NSAID		1 (1.61)	0 (0.00)	1.000
Hypertension		11 (17.74)	3 (23.08)	0.699
Diabetes		3 (4.84)	0 (0.00)	1.000
Family history of hemangioma		0 (0.00)	0 (0.00)	NA
Hepatitis		5 (8.06)	1 (7.69)	1.000
History of surgery and trauma		28 (45.16)	7 (53.85)	0.761
History of radiotherapy and chemotherapy		2 (3.23)	1 (7.69)	0.440
Abnormal coagulation		13 (20.97)	3 (23.08)	0.741
Albumin, g/L		39.34 ± 3.40	37.85 ± 4.76	0.181
Hemoglobin, g/L		85.55 ± 20.69	91.23 ± 23.73	0.333
Thalidomide		11 (19.64)	0 (0.00)	0.580
Method of DBE insertion	Oral	37 (62.71)	6 (66.67)	0.819
	Anal	22 (37.29)	3 (33.33)
Active bleeding		15 (26.79)	1 (16.67)	0.590
Length of operation, minutes		79.14 ± 27.69	90.63 ± 28.59	0.277
Treatment methods	Conservative treatment	6 (9.68)	7 (53.85)	0.003
	Lauromacrogol injection	18 (29.03)	2 (15.38)
	Argon plasma coagulation therapy	21 (33.87)	1 (7.69)
	Ligation therapy	15 (24.19)	3 (23.08)
	Clip therapy	2 (3.23)	0 (0.00)
Blood transfusion volume, mL		234.82 ± 452.56	133.33 ± 326.60	0.596
Lesion size, cm		0.92 ± 0.58	1.41 ± 0.68	0.025
Number of lesions		2.83 ± 2.47	7.91 ± 7.63	< 0.001
Location of lesions	Duodenum	2 (3.23)	2 (15.38)	0.208
	Upper jejunum	14 (22.58)	4 (30.77)
	Lower jejunum	8 (12.90)	2 (15.38)
	Upper ileum	21 (33.87)	1 (7.69)
	Lower ileum	17 (27.42)	4 (30.77)

BMI: Body mass index; NSAID: Nonsteroidal anti-inflammatory drug; DBE: Double-balloon endoscopy; NA: Not available.