Association Between Arterial Calcification and Small Bowel Vascular Lesions: A Comparative Study of Angioectasia and Dieulafoy's Lesions.

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.