{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:49:58Z","timestamp":1792788598205,"version":"4.5.0"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T00:00:00Z","timestamp":1669766400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010425","name":"Tri-Service General Hospital, Taiwan","doi-asserted-by":"crossref","award":["TSGH-D-109073"],"award-info":[{"award-number":["TSGH-D-109073"]}],"id":[{"id":"10.13039\/501100010425","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Department of Defense, Taiwan","award":["MND-MAB-D-111114"],"award-info":[{"award-number":["MND-MAB-D-111114"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background\/Purpose<\/jats:title>\n                    <jats:p>Recurrent obscure gastrointestinal bleeding (OGIB) in patients with chronic kidney disease is a challenge often faced by physicians, given the need for repeated hospitalizations, multiple extensive examinations, limited treatment options, and high medical costs. The purpose of this study was to identify the clinical characteristics of uremic patients undergoing deep enteroscopy for OGIB and analyze the risk factors for rebleeding in these patients after undergoing single-balloon enteroscopy (SBE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Out of 765 patients with OGIB who underwent 1004 procedures of SBE in four teaching hospitals, 78 uremic patients with OGIB were enrolled. Clinical characteristics and endoscopic findings were collected, and multiple variables were analyzed to determine the risk of rebleeding after SBE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The diagnostic yield was 75.6%, and the rebleeding rate was 29.5% in the enrolled uremic patients. The most common etiology was angiodysplasia (74.6%) and the most common site was the jejunum (50.8%). The endoscopic intervention rate was 62.8% and most patients were treated with argon plasma coagulation (75.6%). Among the eight patients with valvular heart disease (VHD), four (50%) had severe aortic stenosis, and the remaining had non-aortic stenosis-VHD. VHD (p &lt; 0.05) and angiodysplasia (p &lt; 0.05) were both associated with a higher rebleeding rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>VHD may be an independent risk factor associated with rebleeding after SBE in uremic patients with OGIB. Moreover, uremic patients with angiodysplasia-related bleeding appear to have a higher rebleeding rate than those with alternative causes of bleeding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0277434","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T13:34:54Z","timestamp":1669815294000},"page":"e0277434","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical characteristics and risk factors for rebleeding in uremic patients with obscure gastrointestinal bleeding undergoing deep enteroscopy: A multi-center retrospective study in Taiwan"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7797-328X","authenticated-orcid":true,"given":"Hsuan-Jen","family":"Hung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9224-4958","authenticated-orcid":true,"given":"Chen-Shuan","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Ming","family":"Tai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Wang","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao-Ming","family":"Tseng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Go-Shine","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-Chiung","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6628-0437","authenticated-orcid":true,"given":"Tien-Yu","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,30]]},"reference":[{"key":"pone.0277434.ref001","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/den.12423","article-title":"Obscure gastrointestinal bleeding: diagnosis and treatment","volume":"27","author":"N Ohmiya","year":"2015","journal-title":"Dig Endosc"},{"key":"pone.0277434.ref002","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.2169\/internalmedicine.51.7190","article-title":"Abnormalities of the small intestine detected by capsule endoscopy in hemodialysis patients","volume":"51","author":"T Ohmori","year":"2012","journal-title":"Intern Med"},{"key":"pone.0277434.ref003","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/j.jfma.2018.10.001","article-title":"Clinical characteristics and risk factors of active bleeding in colonic angiodysplasia among the Taiwanese","volume":"118","author":"YY Tsai","year":"2019","journal-title":"J Formos Med Assoc"},{"key":"pone.0277434.ref004","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/den.12002","article-title":"Factors predicting the presence of small bowel lesions in patients with obscure gastrointestinal bleeding","volume":"25","author":"E Sakai","year":"2013","journal-title":"Dig Endosc"},{"key":"pone.0277434.ref005","doi-asserted-by":"crossref","first-page":"2549","DOI":"10.3748\/wjg.v25.i21.2549","article-title":"Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: A critical review and view points","volume":"25","author":"D Garc\u00eda-Compe\u00e1n","year":"2019","journal-title":"World J Gastroenterol"},{"key":"pone.0277434.ref006","first-page":"113","article-title":"Diagnostic and therapeutic considerations for obscure gastrointestinal bleeding in patients with chronic kidney disease","volume":"32","author":"M Muftah","year":"2019","journal-title":"Ann Gastroenterol"},{"key":"pone.0277434.ref007","first-page":"9026278","article-title":"Diagnostic Value and Safety of Emergency Single-Balloon Enteroscopy for Obscure Gastrointestinal Bleeding","volume":"2019","author":"Y Liu","year":"2019","journal-title":"Gastroenterol Res Pract"},{"key":"pone.0277434.ref008","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1111\/j.1440-1746.2010.06530.x","article-title":"Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis","volume":"26","author":"CW Teshima","year":"2011","journal-title":"J Gastroenterol Hepatol"},{"key":"pone.0277434.ref009","first-page":"5182","article-title":"Wireless capsule endoscopy in the investigation of patients with chronic renal failure and obscure gastrointestinal bleeding (preliminary data)","volume":"12","author":"S Karagiannis","year":"2006","journal-title":"World J Gastroenterol"},{"key":"pone.0277434.ref010","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1016\/j.jfma.2019.01.003","article-title":"Early timing of single balloon enteroscopy is associated with increased diagnostic yield in patients with overt small bowel bleeding","volume":"118","author":"CH Tu","year":"2019","journal-title":"J Formos Med Assoc"},{"key":"pone.0277434.ref011","doi-asserted-by":"crossref","first-page":"2572","DOI":"10.1007\/s10620-013-2588-y","article-title":"Long-term outcomes after single-balloon enteroscopy in patients with obscure gastrointestinal bleeding","volume":"58","author":"VM Kushnir","year":"2013","journal-title":"Dig Dis Sci"},{"key":"pone.0277434.ref012","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.2169\/internalmedicine.3628-19","article-title":"Clinical Characteristics and Risk Factors for Rebleeding in Patients with Obscure Gastrointestinal Bleeding","volume":"59","author":"Y Baba","year":"2020","journal-title":"Intern Med"},{"key":"pone.0277434.ref013","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/00042737-200603000-00009","article-title":"Inter-observer variations on interpretation of capsule endoscopies","volume":"18","author":"LH Lai","year":"2006","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"pone.0277434.ref014","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1097\/MCG.0000000000000836","article-title":"Nonisolated Small Bowel Gastrointestinal Angiodysplasias are Associated with Higher Rebleeding Rates When Compared With Isolated Small Bowel Gastrointestinal Angiodysplasia on Video Capsule Endoscopy","volume":"52","author":"SH Mai","year":"2018","journal-title":"J Clin Gastroenterol"},{"key":"pone.0277434.ref015","article-title":"Risk factors for rebleeding in patients with obscure gastrointestinal bleeding from southern China","volume":"49","author":"B Liu","year":"2021","journal-title":"J Int Med Res"},{"key":"pone.0277434.ref016","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1080\/17474124.2018.1503532","article-title":"An overview of angiodysplasia: management and patient prospects","volume":"12","author":"G Holleran","year":"2018","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"pone.0277434.ref017","doi-asserted-by":"crossref","first-page":"127","DOI":"10.4291\/wjgp.v8.i3.127","article-title":"Assessment of serum angiogenic factors as a diagnostic aid for small bowel angiodysplasia in patients with obscure gastrointestinal bleeding and anaemia","volume":"8","author":"G Holleran","year":"2017","journal-title":"World J Gastrointest Pathophysiol"},{"key":"pone.0277434.ref018","doi-asserted-by":"crossref","first-page":"471","DOI":"10.3390\/cells8050471","article-title":"Role of Angiopoietin-2 in Vascular Physiology and Pathophysiology","volume":"8","author":"RG Akwii","year":"2019","journal-title":"Cells"},{"key":"pone.0277434.ref019","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1111\/j.1525-139X.2006.00179.x","article-title":"Platelet dysfunction and end-stage renal disease","volume":"19","author":"D Kaw","year":"2006","journal-title":"Semin Dial"},{"key":"pone.0277434.ref020","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1056\/NEJM195807242590416","article-title":"Gastrointestinal bleeding in aortic stenosis","volume":"259","author":"E. Heyde","year":"1958","journal-title":"N Engl J Med"},{"key":"pone.0277434.ref021","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/0140-6736(92)92434-H","article-title":"Aortic stenosis and bleeding gastrointestinal angiodysplasia: is acquired von Willebrand\u2019s disease the link?","volume":"340","author":"TE Warkentin","year":"1992","journal-title":"Lancet"},{"key":"pone.0277434.ref022","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1056\/NEJMoa022831","article-title":"Acquired von Willebrand syndrome in aortic stenosis","volume":"349","author":"A Vincentelli","year":"2003","journal-title":"N Engl J Med"},{"key":"pone.0277434.ref023","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.ijscr.2018.10.078","article-title":"A surgical case of aortic stenosis with recurrent gastrointestinal bleeding: Heyde syndrome","volume":"53","author":"M Iijima","year":"2018","journal-title":"Int J Surg Case Rep"},{"key":"pone.0277434.ref024","doi-asserted-by":"crossref","first-page":"2720","DOI":"10.3748\/wjg.v25.i22.2720","article-title":"Diagnosis and therapeutic strategies for small bowel vascular lesions","volume":"25","author":"E Sakai","year":"2019","journal-title":"World J Gastroenterol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0277434","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T13:35:28Z","timestamp":1669815328000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0277434"}},"subtitle":[],"editor":[{"given":"Hsu-Heng","family":"Yen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,11,30]]},"references-count":24,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0277434","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,30]]}}}