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

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 risk factors of 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 the 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 risk factors and clinical outcomes. Results Among patients with SSBB who underwent SBE, the diagnostic yield 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 angiodysplasia (88.89%) and ulcers (30.6%). Among patients with end-stage renal disease (ESRD), dialysis, or anticoagulation drug use, vascular lesions were significantly more common than nonvascular lesions. Most patients with vascular and nonvascular lesions were treated with argon plasma coagulation (74.6%) and surgery (22.45%), respectively. Conclusion In our study, angiodysplasia was the most common vascular lesion etiology in patients with SSBB. Uremia is an independent predictor of vascular lesions in patients with SSBB, and patients undergoing dialysis may represent a high-risk population. In conclusion, most patients with SSBB and vascular lesions can be diagnosed and treated using deep enteroscopy. However, surgical or vascular interventions are necessary in certain situations.