Non-steroidal anti-inflammatory drug-induced enteropathy as a major risk factor for small bowel bleeding: a retrospective study.

BACKGROUND: Small bowel (SB) bleeding accounts for 5% of all gastrointestinal (GI) bleeding cases and 80% of obscure GI bleeding cases. Although angioectasia is the common etiology of SB bleeding, nonsteroidal anti-inflammatory drug (NSAID)-induced SB lesions are also reported as a major cause in studies from Eastern countries. Herein, we assessed the frequency of occurrence of NSAID-induced SB lesions in Korean patients with obscure GI bleeding. METHODS: We retrospectively analyzed medical records of all consecutive patients aged ≥18 years who underwent capsule endoscopy from March 2018 to February 2019 at Ulsan University Hospital and Kosin University Gospel Hospital. RESULTS: Of the 83 subjects (all Korean; mean age ± standard deviation: 59 ± 18 years; age range: 18-84 years; men: n = 52; women: n = 31), 55 (66.2%) had stool with clear blood and 28 (33.8%) had normal stool with iron deficiency anemia. The detection rate of SB bleeding and lesions using capsule endoscopy was 72.3% (60 of 83 patients). A significantly higher frequency (40 of 51) of ulcerative/erosive lesions than other causes was observed in patients with inactive bleeding but visible SB lesions. As a result, NSAID-induced enteropathy accounted for 30.1% of 83 patients with obscure GI bleeding (25 of the all 60 SB bleeding cases). CONCLUSIONS: Contrary to what is reported for patients in Western countries, this study in Korean patients showed an improved diagnostic yield of capsule endoscopy for obscure GI bleeding and that NSAID-induced enteropathy was the most common etiology of SB bleeding. Aggressive small intestine examination is required for patients with unexplained GI bleeding.

Large duodenal hematoma associated with transcatheter arterial embolization following endoscopic hemostasis in a cirrhosis patient: case report.

To date, there has been no report on duodenal intramural hematoma following transcatheter arterial embolization in bleeding duodenal ulcer refractory to endoscopic hemostasis. We experienced a case of obstructive cholangitis and pancreatitis secondary to duodenal intramural hematoma associated with transcatheter arterial embolization, following endoscopic hemostatic procedures for a bleeding duodenal ulcer in a patient with cirrhosis. The patient was successfully treated with percutaneous transhepatic biliary drainage. We suggest that transcatheter arterial embolization can be a cause of duodenal intramural hematoma, and that percutaneous transhepatic biliary drainage, rather than surgical intervention, can be useful in the treatment of biliary or pancreatic obstruction secondary to duodenal intramural hematoma, especially in patients with bleeding diathesis.