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Rimondi A, Sorge A, Murino A, Nandi N, Scaramella L, Vecchi M, Tontini GE, Elli L. Treatment options for gastrointestinal bleeding blue rubber bleb nevus syndrome: Systematic review. Dig Endosc 2024; 36:162-171. [PMID: 37029779 DOI: 10.1111/den.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/05/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES Blue rubber bleb nevus syndrome (BRBNS) is a rare challenging cause of gastrointestinal bleeding. We performed a systematic review of case reports and case series on BRBNS to gather information on the treatment options currently available. METHODS All studies reporting a case of BRBNS in humans were evaluated. Papers were ruled out if CARE criteria and explanations on patient's selection, ascertainment, causality, and reporting were not respected or identified. PROSPERO 2021 CRD 42021286982. RESULTS Blue rubber bleb nevus syndrome was treated in 106 cases from 76 reports. 57.5% of the population was under 18 years old, and up to 50% of the cases reported a previous treatment. Clinical success was achieved in 98 patients (92.4%). Three main types of interventions were identified: systemic drug therapy, endoscopy, and surgery. After BRBNS recurrence or previous therapy failure, systemic drug therapy emerged as a preferred second-line treatment over endoscopy (P = 0.01), but with a higher rate of reported adverse events when compared with surgery and endoscopy (P < 0.001). Endoscopic treatment was associated with a higher number of required sessions to achieve complete eradication when compared with surgery (P < 0.001). No differences between the three main areas were found in the overall follow-up time (P = 0.19) or in the recurrence rate (P = 0.45). CONCLUSION Endoscopy, surgery, and systemic drug therapy are feasible treatment options for BRBNS. Systemic drug therapy was the favorite second-line treatment after endoscopic failure or recurrence of BRBNS, but adverse events were more frequently reported.
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Affiliation(s)
- Alessandro Rimondi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Sorge
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, UK
- Department of Gastroenterology, Cleveland Clinic London, London, UK
| | - Nicoletta Nandi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucia Scaramella
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Yang J, Zhou L, Xu D, Fan Y, Zhang H. Endoscopic injection sclerotherapy for treating recurrent bleeding of small bowel angioectasias. BMC Gastroenterol 2023; 23:233. [PMID: 37434106 PMCID: PMC10334616 DOI: 10.1186/s12876-023-02836-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND There is still no consensus on the preferred endoscopic therapy for small bowel angioectasias (SBAs). The aim of this study was to evaluate effectiveness and safety of endoscopic injection sclerotherapy (EIS) for treating recurrent bleeding of SBAs. METHODS Sixty-six adult patients diagnosed with SBAs by capsule endoscopy (CE) or double-balloon enterscopy (DBE) examinations were enrolled in this retrospective study from September 2013 to September 2021. The patients were divided into an EIS group (35 cases) and a control group (31 cases) according to whether they underwent EIS treatment. Clinical characteristics, medical histories, lesion characteristics, main laboratory indicators, treatments, and outcomes were collected. The rates of re-bleeding, re-admission, and red blood cell (RBC) transfusion were compared between different groups after discharge. The rates of hospitalization and RBC transfusion were compared between before admission and after discharge in both groups. Odds ratios (ORs) and 95% confidence intervals (CIs) were used in the multivariate logistic regression analysis to assess relative factors for re-bleeding. RESULTS All the rates of re-bleeding, re-admission and RBC transfusion after discharge in the EIS group were significantly lower than those in the control group (all P < 0.05). The rates of hospitalization and RBC transfusion after discharge were significantly lower than those before admission in the EIS group (both P < 0.05), while those did not reach significant differences in the control group (both P > 0.05). Multivariate logistic regression analysis showed that RBC transfusion before admission (OR, 5.655; 95% CI, 1.007-31.758, P = 0.049) and multiple lesions (≥ 3) (OR, 17.672; 95% CI, 2.246-139.060, P = 0.006) were significant risk factors of re-bleeding, while EIS treatment (OR, 0.037; 95% CI, 0.005-0.260, P < 0.001) was a significant protective factor. No endoscopic adverse events were observed during hospitalization and none of the enrolled patients died within 12 months after discharge. CONCLUSION EIS treatment had good effectiveness and safety for treating recurrent bleeding of SBAs, which could be considered as one of the first-line endoscopic treatment options for SBAs.
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Affiliation(s)
- Jing Yang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No.26, Shengli Street, Jiang'an District, Wuhan, Hubei Province, 430014, China
| | - Lei Zhou
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No.26, Shengli Street, Jiang'an District, Wuhan, Hubei Province, 430014, China
| | - Dan Xu
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No.26, Shengli Street, Jiang'an District, Wuhan, Hubei Province, 430014, China
| | - Yan Fan
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No.26, Shengli Street, Jiang'an District, Wuhan, Hubei Province, 430014, China.
| | - Heng Zhang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No.26, Shengli Street, Jiang'an District, Wuhan, Hubei Province, 430014, China.
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Cavazos Castro A, Espinosa Guerrero E, Pajaro Vallín A, Asz Sigall J. Surgical treatment and pneumatic reduction for intussusception in a pediatric patient with blue rubber bleb nevus syndrome. Journal of Pediatric Surgery Case Reports 2022. [DOI: 10.1016/j.epsc.2022.102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Unoura S, Toya Y, Kasugai S, Kumei T, Yamazato M, Sasaki Y, Eizuka M, Oizumi T, Morishita T, Tagane S, Shiohata T, Yanai S, Akasaka M, Matsumoto T. Successful endoscopic sclerotherapy with bile duct stenting for a vascular malformation neighboring the duodenal papilla in blue rubber bleb nevus syndrome. DEN Open 2022; 2:e113. [PMID: 35873521 PMCID: PMC9302048 DOI: 10.1002/deo2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 06/15/2023]
Abstract
A 14-year-old girl, who had been diagnosed with blue rubber bleb nevus syndrome, was referred to our hospital because of iron deficiency anemia. Esophagogastroduodenoscopy revealed a dark and red-colored vascular malformation occurring just above the duodenal papilla. Because the lesion was regarded as the cause of the anemia, we performed polidocanol injection therapy with bile duct stenting. Since esophagogastroduodenoscopy performed a month later revealed a scarred ulcer, the bile duct stent was removed. She has been under observation as an outpatient without any symptoms.
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Affiliation(s)
- Shingo Unoura
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Yosuke Toya
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Satoshi Kasugai
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Tomo Kumei
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Masanao Yamazato
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Yutaka Sasaki
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Makoto Eizuka
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Tomofumi Oizumi
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Toshifumi Morishita
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Seiya Tagane
- Department of PediatricsSchool of MedicineIwate Medical UniversityIwateJapan
| | - Takeshi Shiohata
- Department of PediatricsSchool of MedicineIwate Medical UniversityIwateJapan
| | - Shunichi Yanai
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Manami Akasaka
- Department of PediatricsSchool of MedicineIwate Medical UniversityIwateJapan
| | - Takayuki Matsumoto
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
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Dooghaie Moghadam A, Bagheri M, Eslami P, Farokhi E, Nezami Asl A, Khavaran K, Iravani S, Saeedi S, Mehrvar A, Dooghaie-Moghadam M. Blue Rubber Bleb Nevus Syndrome because of 12 Years of Iron Deficiency Anemia in a Patient by Double Balloon Enteroscopy; A Case Report and Review of Literature. Middle East J Dig Dis 2021; 13:153-159. [PMID: 34712454 PMCID: PMC8531930 DOI: 10.34172/mejdd.2021.219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/03/2021] [Indexed: 01/10/2023] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder comprised of venous malformation mostly involving the skin and gastrointestinal (GI) tract but can also involve other visceral organs. The most predominant site of GI tract involvement is the small bowel. In patients with GI lesions, treatment depends on the severity of bleeding, and extent of involvement. Conservative therapy with iron supplementation and blood transfusion is appropriate in cases with mild bleeding but in severe cases endoscopic and surgical interventions would be beneficial. Also, medical therapy with sirolimus significantly reduces bleeding. A 20-year-old woman was referred to our hospital after transfusion of six units of packed cell because of several episodes of lower GI bleeding within the past three months in the form of melena and a single episode of hematochezia. Her last hemoglobin level before admission was 10mg/dl. She underwent various unsuccessful investigations since she was eight years old to find the origin of refractory iron deficiency anemia. In upper endoscopy, five bleeding polypoid lesions were discovered in the jejunum. Lesions were excised by snare polypectomy. Over a six-month follow-up period, no signs of lower GI bleeding were noted and the patient had a normal hemoglobin level.
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Affiliation(s)
- Arash Dooghaie Moghadam
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Bagheri
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Eslami
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ermia Farokhi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Nezami Asl
- Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Karim Khavaran
- Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Shahrokh Iravani
- Research Center for Cancer Screening and Epidemiology, AJA University of Medical Sciences, Tehran, Iran.,Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Sandra Saeedi
- Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Azim Mehrvar
- Research Center for Cancer Screening and Epidemiology, AJA University of Medical Sciences, Tehran, Iran
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Abstract
PURPOSE OF REVIEW To provide an update of vascular malformation syndromes by reviewing the most recent articles on the topic and following the new International Society for the Study of Vascular Anomalies (ISSVA) 2018 classification. RECENT FINDINGS This review discusses the main features and diagnostic approaches of the vascular malformation syndromes, the new genetic findings and the new therapeutic strategies developed in recent months. SUMMARY Some vascular malformations can be associated with other anomalies, such as tissue overgrowth. PIK3CA-related overgrowth spectrum (PROS) is a group of rare genetic disorders with asymmetric overgrowth caused by somatic mosaic mutations in PI3K-AKT-mTOR pathway that encompass a heterogeneous group of rare disorder that are associated with the appearance of overgrowth. CLOVES syndrome and Klippel-Trénaunay syndrome are PROS disease. Proteus syndrome is an overgrowth syndrome caused by a somatic activating mutation in AKT1. CLOVES, Klippel-Trénaunay and Proteus syndromes are associated with high risk of thrombosis and pulmonary embolism. Hereditary hemorrhagic telangiectasia is an autosomic dominant disorder characterized by the presence of arteriovenous malformations. New therapeutic strategies with bevacizumab and thalidomide have been employed with promising results.
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Affiliation(s)
- Antonio Martinez-Lopez
- Dermatology Unit, Hospital Universitario Virgen de las Nieves
- Instituto de Investigacio[Combining Acute Accent]n Biosanitaria ibs.GRANADA
| | | | | | - Alejandro Molina-Leyva
- Dermatology Unit, Hospital Universitario Virgen de las Nieves
- Instituto de Investigacio[Combining Acute Accent]n Biosanitaria ibs.GRANADA
| | - Jesus Tercedor-Sanchez
- Dermatology Unit, Hospital Universitario Virgen de las Nieves
- Instituto de Investigacio[Combining Acute Accent]n Biosanitaria ibs.GRANADA
| | - Salvador Arias-Santiago
- Dermatology Unit, Hospital Universitario Virgen de las Nieves
- Instituto de Investigacio[Combining Acute Accent]n Biosanitaria ibs.GRANADA
- Dermatology Department, University of Granada, Granada, Spain
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