Abstract Number: PB1572
Meeting: ISTH 2020 Congress
Background: Video capsule endoscopy (VCE) is the gold standard endoscopic investigation to look for small-bowel angiodysplasia when no gastrointestinal bleeding (GIB) source is identified on conventional endoscopy. We hypothesized that VCE could improve the diagnosis yield of GIB in patients with constitutional von Willebrand disease (VWD), a population prone to angiodysplasia.
Aims: To assess the diagnostic yield and prognosis value of VCE on top of conventional endoscopy in constitutional VWD-patients with GIB.
Methods: A survey was sent to the centers of the French MHEMO-network to identify constitutional VWD-patients referred for endoscopic exploration of at least one GIB episode from 1 January 2015 to 31 December 2017. We analyzed patient characteristics (including VWD phenotype), GIB pattern, the modalities and results of each endoscopic exploration and the medical management applied (including endoscopic therapy with argon plasma coagulation). We assessed the re-bleeding-free interval after first GIB according to the underlying VWD or to the result of endoscopic exploration (categorized as “angiodyplasia”, “no-angiodysplasia” or “occult GIB”) by Kaplan-Meier method. In VWD-patients with angiodysplasia, another survival analysis was performed to assess the rate of GIB-recurrence according to the presence of small-bowel angiodysplasia on VCE.
Results: 129 GIB-episodes were reported in 50 VWD-patients. Angiodysplasia was the most frequent GIB-etiology. Angiodysplasia diagnosis was significantly improved when using VCE on top of conventional endoscopy (all cases p=0.001, incident cases p=0.03). VWD-patients with angiodysplasia had a higher number of GIB recurrences (p=0.008) and a lower rebleeding-free interval after first GIB-episode (log rank test, p=0.02). Accordingly, the re-bleeding rate was significantly higher in VWD-patients with small-bowel angiodysplasias (log rank test, p=0.005; Figure).
Conclusions: The use of VCE in VWD-patients with GIB improves the diagnostic yield for angiodysplasia and the risk stratification for bleeding recurrence.
To cite this abstract in AMA style:Rauch A, Paris C, Repesse Y, Branche J, Gerard R, D'Oiron R, Harroche A, Ternisien C, Castet S, Lebreton A, Pan-Petesch B, Volot F, Clayssens S, Chamouni P, Gay V, Veyradier A, Goudemand J, Susen S. Gastrointestinal Bleeding from Angiodysplasia in Constitutional von Willebrand Disease: Improved Diagnosis Yield and Risk Stratification when Using Video Capsule on Top of Conventional Endoscopy [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/gastrointestinal-bleeding-from-angiodysplasia-in-constitutional-von-willebrand-disease-improved-diagnosis-yield-and-risk-stratification-when-using-video-capsule-on-top-of-conventional-endoscopy/. Accessed December 3, 2021.
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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/gastrointestinal-bleeding-from-angiodysplasia-in-constitutional-von-willebrand-disease-improved-diagnosis-yield-and-risk-stratification-when-using-video-capsule-on-top-of-conventional-endoscopy/