THE ENDOSCOPIC FEATURES OF GASTROINTESTINAL ANGIODYSPLASIA BEFORE AND AFTER TREATMENT OF SEVERE AORTIC STENOSIS : A PROSPECTIVE STUDY

BACKGROUND: Most severe aortic stenosis (AS) patients with moderate/severe anemia were found to have gastrointestinal angiodysplasia lesions, which disappeared or shrank on treatment with transcatheter aortic valve replacement (TAVR) (N Engl J Med, 2023). We thus evaluated the clinical features of AS-associated angiodysplasia and active bleeding.
METHODS: This was a post-hoc analysis of data collected in a prospective study (UMIN-CTR, UMIN 000038948) at Kyoto Prefectural University of Medicine between January 2020 and December 2021 involving 50 patients scheduled to undergo TAVR to treat severe AS with hemoglobin levels <11.0 g/dL. All enrolled patients underwent an endoscopic examination of the entire gastrointestinal tract within three months before TAVR. Patients with angiodysplasia lesions at baseline underwent repeat endoscopy for a reevaluation of angiodysplasia 6–12 months after TAVR. The primary outcomes were the frequency, number, size of angiodysplasia lesions, and presence of active bleeding, while the secondary outcome was the changes observed after TAVR.
RESULTS: Gastrointestinal angiodysplasia was detected in 94% (47/50) of patients, including 26% (13/50) (8%, 4%, 14%, and 4%), 67% (33/49) (45%, 25%, 35%), and 47% (23/49) (41%, 24%, and 6%) in the duodenum (upper, middle, lower, duodenum), small intestine (upper, middle, lower), and colon (right, left, and rectum), respectively. The mean (±standard deviation) number of angiodysplasia lesions per patient before TAVR was 11.0±18.3 (550/50) throughout the gastrointestinal tract, including 2.6±8.4 (131/50), 2.6±4.6 (130/49) and 5.8±13.8 (289/49) in the stomach-duodenum, small intestine, and colon, respectively. The mean (±standard deviation) size of the detected lesions was 3.7±4.1 mm, including 1.3±0.8, 3.8±2.4, and 4.8±5.1 mm in the stomach-duodenum, small intestine, and colon, respectively. While patients had a stable status without subjective complaints of gastrointestinal bleeding, active bleeding was detected in 10% (5/50), including 2% (1/50), 4% (2/50), and 4% (2/50) from the lower stomach, upper small intestine, and right colon, respectively. Follow-up endoscopy performed at a mean (±standard deviation) of 8.2±1.8 months after TAVR in 31 patients revealed a decrease in the mean number of angiodysplasia lesions per patient, from 9.0±12.2 before TAVR to 4.0±5.1 after TAVR (p=0.009). The mean diameter of the lesions decreased from 2.5±2.9 to 1.4±3.1 mm (p=0.0001). No patient experienced active bleeding at the time of follow-up endoscopy.
CONCLUSION: Most severe AS patients with anemia had angiodysplasia, and active bleeding was detected in 10% of these patients, being more frequent in the lower stomach, upper small intestine, and right colon than elsewhere. After TAVR, the number and size of the angiodysplasia lesions was reduced, and no patient experienced active bleeding.