ORIGINAL ARTICLE Favorable long-term outcomes of repeat endotherapy for small-intestine vascular lesions by double-balloon endoscopy Satoshi Shinozaki, MD, PhD, 1 Hironori Yamamoto, MD, PhD, 1 Tomonori Yano, MD, PhD, 1 Keijiro Sunada, MD, 1 Yoshikazu Hayashi, MD, PhD, 1 Hakuei Shinhata, MD, 1 Hiroyuki Sato, MD, PhD, 1 Edward J. Despott, MD, MRCP, 2 Kentaro Sugano, MD, PhD 1 Tochigi, Japan Background: GI bleeding secondary to small-intestine vascular lesions (SIVLs) is associated with rebleeding despite initial hemostasis by endotherapy applied at double-balloon endoscopy (DBE). Objective: To evaluate the long-term outcomes of DBE endotherapy of SIVL (as described by the Yano- Yamamoto classification). The impact of repeat DBE endotherapy for recurrent bleeding also was assessed. Design: Retrospective cohort study. The mean ( standard deviation [SD]) follow-up period was 4.9 ( 1.7) years (range 2.4-9.1 years). Setting: Tertiary-care referral center. Patients: A total of 43 patients, who underwent 69 sessions of DBE endotherapy of SIVLs. Intervention: DBE endotherapy. Main Outcome Measurements: Frequency of overt rebleeding after the initial DBE endotherapy. Results: Overt rebleeding occurred in 16 of 43 patients (37%). Patients with multiple SIVLs showed a significantly higher rate of overt rebleeding than did those with a solitary SIVL (12/23 [52%] vs 4/20 [20%]; P Z .017). The trend toward frequency of rebleeding after the first DBE hemostasis appeared to be higher for patients with type 1a SIVLs than for those with type 1b or type 2 lesions: type 1a (8/16, 50%) versus type 1b (5/19, 26%) (P Z .12) and type 1a (8/16, 50%) versus type 2 (2/7, 29%) (P Z .31), respectively. In 12 of 16 patients (75%) who underwent repeat DBE endotherapy at each episode of overt rebleeding (median 3 times, range 2-6), the frequency of rebleeding decreased significantly after the first year of follow-up, as compared with the remaining 4 patients who did not undergo repeat DBE; mean ( SD) 0.12 ( 0.19) versus 0.52 ( 0.33) times per year per patient (P Z .006). Limitations: Single-center, retrospective study. Conclusion: Although the presence of multiple SIVLs was associated with rebleeding, repeat DBE endotherapy resulted in an improved long-term outcome in patients with refractory SIVL bleeding. (Gastrointest Endosc 2014;-:1-6.) Abbreviations: CE, capsule endoscopy; DBE, double-balloon endoscopy; MGIB, mid-GI bleeding; OGIB, obscure GI bleeding; SIVL, small-intestine vascular lesion. DISCLOSURE: H. Yamamoto is a consultant to Fujifilm Corporation and has received honoraria, grants, and royalties. K. Sunada has received a donation from Fujifilm Corporation. E. Despott has received grants from Fujifilm Corporation and Imotech Medical UK. No other financial relationships relevant to this publication were disclosed. Copyright ª 2014 by the American Society for Gastrointestinal Endoscopy 0016-5107/$36.00 http://dx.doi.org/10.1016/j.gie.2013.11.029 Received April 30, 2013. Accepted November 18, 2013. Current affiliations: Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan (1); Royal Free Unit for Endoscopy and Centre for Gastroenterology, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, United Kingdom (2). Reprint requests: Hironori Yamamoto, MD, PhD. Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan. www.giejournal.org Volume -, No. - : 2014 GASTROINTESTINAL ENDOSCOPY 1