Digestive diseases and sciences · 2026
Association Between Arterial Calcification and Small Bowel Vascular Lesions: A Comparative Study of Angioectasia and Dieulafoy's Lesions.
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Shigenobu Shuya, Tsuboi Akiyoshi, Fukuda Kaho, Ooka Tatsuko, Sugata Shuhei, Koh Nobuaki, Kamigaichi Yuki, Takasago Takeshi, Tanaka Hidenori, Yamashita Ken, Hiyama Yuichi, Kishida Yoshihiro, Takigawa Hidehiko, Urabe Yuji, Kuwai Toshio, Oka Shiro
Аннотация
BACKGROUND: Small-bowel vascular lesions are a major cause of bleeding. The Yano-Yamamoto classification defines angioectasia and Dieulafoy lesions as Types 1 and 2, respectively.
AIMS: To investigate clinical differences between the above lesion types and their associations with systemic arteriosclerosis.
METHODS: We retrospectively analyzed 145 patients with small-bowel vascular lesions (125 Type 1; 20 Type 2) diagnosed using double-balloon enteroscopy. Clinical characteristics, comorbidities, updated Charlson Comorbidity Index, and Ohmiya index were compared. Arteriosclerosis was assessed using computed tomography-based arterial calcification and modified Agatston score. Rebleeding rates were analyzed using the Kaplan-Meier method.
RESULTS: Type 2 lesions were significantly associated with overt bleeding (85 vs. 55%, P = 0.012), lower hemoglobin (6.79 vs. 8.03 g/dL, P = 0.018), severe anemia (60 vs. 30%, P < 0.01), blood transfusion (80 vs. 43%, P < 0.01), and active bleeding on capsule endoscopy (80 vs. 41%, P < 0.01). Conversely, Type 1 lesions showed higher prevalence of cardiovascular disease (51 vs. 25%, P = 0.029), cirrhosis (35 vs. 0%, P < 0.01), updated Charlson Comorbidity Index ≥ 4 (38 vs. 15%, P = 0.049), and Ohmiya index ≥ 2 (45 vs. 20%, P = 0.037). Type 1 lesions showed higher superior mesenteric artery calcification (61 vs. 33%, P = 0.033) and median modified Agatston scores (8154 vs. 377, P = 0.039). Type 1 small-bowel vascular lesions with rebleeding had higher median modified Agatston scores (8698 vs. 6781, P < 0.01); scores ≥ 7502 were associated with increased rebleeding risk (P = 0.028).
CONCLUSIONS: Type 1 lesions were associated with systemic comorbidities and greater arterial calcification, while higher Agatston scores were associated with increased rebleeding risk.
AIMS: To investigate clinical differences between the above lesion types and their associations with systemic arteriosclerosis.
METHODS: We retrospectively analyzed 145 patients with small-bowel vascular lesions (125 Type 1; 20 Type 2) diagnosed using double-balloon enteroscopy. Clinical characteristics, comorbidities, updated Charlson Comorbidity Index, and Ohmiya index were compared. Arteriosclerosis was assessed using computed tomography-based arterial calcification and modified Agatston score. Rebleeding rates were analyzed using the Kaplan-Meier method.
RESULTS: Type 2 lesions were significantly associated with overt bleeding (85 vs. 55%, P = 0.012), lower hemoglobin (6.79 vs. 8.03 g/dL, P = 0.018), severe anemia (60 vs. 30%, P < 0.01), blood transfusion (80 vs. 43%, P < 0.01), and active bleeding on capsule endoscopy (80 vs. 41%, P < 0.01). Conversely, Type 1 lesions showed higher prevalence of cardiovascular disease (51 vs. 25%, P = 0.029), cirrhosis (35 vs. 0%, P < 0.01), updated Charlson Comorbidity Index ≥ 4 (38 vs. 15%, P = 0.049), and Ohmiya index ≥ 2 (45 vs. 20%, P = 0.037). Type 1 lesions showed higher superior mesenteric artery calcification (61 vs. 33%, P = 0.033) and median modified Agatston scores (8154 vs. 377, P = 0.039). Type 1 small-bowel vascular lesions with rebleeding had higher median modified Agatston scores (8698 vs. 6781, P < 0.01); scores ≥ 7502 were associated with increased rebleeding risk (P = 0.028).
CONCLUSIONS: Type 1 lesions were associated with systemic comorbidities and greater arterial calcification, while higher Agatston scores were associated with increased rebleeding risk.