AORTOENTERIC AND ARTERIO-ENTERIC FISTULA BLEEDING – WHAT IS THE ROLE OF ENDOSCOPY?

Aims:

The aim of this study was to show epidemiological, clinical and endoscopic characteristics of patients bleeding from an aortoenteric (AOEF) or arterio-enteric fistula (AEF) including thirty-day rebleeding rate, mortality and the need for blood transfusion.

Methods:

This prospective study included a total of 6 patients in a period of 8 years (from January 2008 till December 2016) with bleeding from AOEF or AEF from a total of 3516 patients referred to our Emergency Department with upper gastrointestinal bleeding (UGIB).

Results:

Cumulative incidence of UGIB was 127/100000 in an 8-year period with 0.002% of patients bleeding from AOEF or AEF. Three patients had AOEF bleeding and three presented with AEF bleeding. Two (33.3%) patients were bleeding from a primary, and 4 (66.7%) patients were bleeding from a secondary AEF or AOEF. The majority of patients were male (83.3%). Median age of patients with AOEF and AEF was 68.7 and 56.3 years respectively. The time from Emergency department admission to diagnosis ranged from 2 hours to 14 days. In most patients the diagnosis was made using computed tomography angiography, and in two patients the fistula opening was found endoscopically (esophagogastroduodenoscopy and enteroscopy respectively).

Two patients bleeding from AOEF died (causes of death were bleeding and pneumonia respectively). All patients bleeding from AOEF underwent surgical treatment, while most patients bleeding from an AEF were treated using transarterial embolization. There were no cases of re-bleeding. Thirty-day mortality was higher in patients with AOEF bleeding. Patients bleeding from an AOEF received more transfusions of red blood cell units compared to patients bleeding from an AEF (12.3 vs. 10.3).

Conclusions:

AOEF and AEF bleeding is a rare, potentially fatal, cause of UGIB which can be found using endoscopy in only one third of cases.