Double balloon enteroscopy in hereditary hemorrhagic telangiectasia: A retrospective case series

Double balloon enteroscopy (DBE) with argon plasma coagulation (APC) is an effective treatment for small bowel gastrointestinal bleeding but is not thoroughly studied in patients with hereditary hemorrhagic telangiectasia (HHT).We conducted a study of HHT patients who underwent DBE at an academic referral center from 2011-2021.Fourteen patients underwent 26 DBEs; median age was 57; most were on antifibrinolytic or antiangiogenic therapy.Most scopes identified > 20 arteriovenous malformations (AVMs); 34.6% of DBEs reported > 100 AVMs.Nearly all lesions were treated with APC.No post-procedure adverse events occurred in this cohort.Patients who had their procedures at the HHT Center and those with 21-100 AVMs required less blood transfusions in the year following DBE.DBE-directed therapy was found to be safe in HHT patients; it may be especially helpful when performed in an HHT Center (likely due to improved interdisciplinary care) or in those with 21-100 AVMs.