Award: Presidential Poster Award
Bahaaeldeen Ismail, MD1, Mhd Suhaib Alayoubi, MD2, Moaz Abdelwadoud, MD, DrPH, MPH3, Fernando Castro, MD4
1University of Kentucky College of Medicine, Lexington, KY; 2McLaren Flint Hospital, Flint, MI; 3University of Maryland School of Pharmacy, Baltimore, MD; 4Digestive Disease Institute, Cleveland Clinic Foundation, Weston, FL
Introduction: Endoclips have been used for treating bleeding gastrointestinal angiodysplasias (GIAD), but the supporting evidence in the literature has been limited. We previously presented a retrospective study that showed a significantly lower rebleeding rate with clips compared to argon plasma photocoagulation (APC); however, the sample size was small particularly the number of patients receiving antithrombotics (ATs). Aim of the current study is to compare the rebleeding rate with the use of clips versus APC in patients with bleeding GIAD receiving ATs.
Methods: We retrospectively included adults with bleeding GIAD that received either APC, clips monotherapy or in combination, at any of the Cleveland Clinic hospitals between 1/1/2009 to 11/1/2016. Only patients who resumed ATs after the intervention were included. Charts were reviewed to collect baseline and outcome characteristics.
Results: 178 patients were included, 92 received APC, 28 received clips monotherapy and 58 received clips combined with a second modality. At baseline, the clips group had more single GIADs, more actively bleeding lesions on index endoscopy and a tendency towards more overt bleeding. Baseline characteristics were otherwise similar [table 1]. Median follow up duration was 18.5 months [IQR 9.9- 27.3]. Rebleeding was significantly lower in the clips group (34.9% compared to 51.1% for APC, p=0.03). The probability of remaining free of rebleeding was also higher in the clips group compared to APC (p=0.037) [figure 1a] but not significantly different when patients were classified into 3 groups [figure 1b]. On a multivariate hazards regression model [table 2], receiving clips combined with a second modality was predictive of lower rebleeding (HR 0.46 (0.25-0.84)). Other significant factors were having a smaller sized GIAD and having higher hemoglobin nadir at the initial bleed.
Discussion: Clips were associated with a lower probability of rebleeding in patients with GIADs receiving ATs compared to APC. After accounting for potential confounders, using clips in combination with a second modality remained significant, suggesting a role for combined intervention in patients that will resume ATs after endoscopic therapy.
Reference: Ismail, B., Lara, L. F. & Charles, R. (2017). Hemostatic Clip Use in Bleeding Gastrointestinal Arteriovenous Malformations, Retrospective Single Center Experience. Gastrointestinal Endoscopy, 5(85), AB420-AB421.
Citation: Bahaaeldeen Ismail, MD; Mhd Suhaib Alayoubi, MD; Moaz Abdelwadoud, MD, DrPH, MPH; Fernando Castro, MD. P0397 - REBLEEDING AFTER HEMOCLIP VERSUS ARGON PLASMA COAGULATION USE FOR BLEEDING GASTROINTESTINAL ANGIODYSPLASIAS IN PATIENTS RECEIVING ANTITHROMBOTICS: A RETROSPECTIVE MULTI-CENTER STUDY. Program No. P0397. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.