Gastrointestinal angiodysplasias are acquired vascular malformations of the gastrointestinal mucosa and submucosa and constitute a major cause of suspected small-bowel bleeding (SSBB) and iron-deficiency anemia (IDA). Small-bowel capsule endoscopy (SBCE) is the primary diagnostic tool. Standard management includes iron replacement therapy (IRT), transfusion support, and optimization of anticoagulation or antiplatelet therapy. Device-assisted enteroscopy (DAE), although recommended for endoscopic thermocoagulation, shows high rebleeding rates and is available only in a small number of referral centers in Greece, limiting its feasibility in routine care. Long-acting somatostatin analogues (SSA) represent an alternative therapeutic option for recurrent or refractory bleeding. The aim of this study was to evaluate the characteristics, management patterns, and 12-month clinical outcomes of patients with capsule-diagnosed small-bowel angiodysplasias in a real-world setting without readily accessible DAE.

We conducted a retrospective descriptive cohort study including 26 patients with SBCE-confirmed small-bowel angiodysplasias. Demographic characteristics, comorbidities, medication history, indication for SBCE, duration of symptoms, prior treatments, SBCE findings, therapeutic interventions, and 12-month outcomes were recorded and analyzed descriptively.

The median age of the cohort was 69.5 years (IQR 63–79), and 50% were male. IDA was the indication for SBCE in 14/26 patients, while 50% underwent SBCE during hospitalization. Ischemic heart disease was the most common comorbidity, and 30.8% were receiving single antiplatelet therapy. SBCE revealed active bleeding in 7/26 patients, multiple angiodysplasias in 57.7%, and exclusive small-bowel involvement in 76.9%. Patients with IDA were younger and predominantly outpatients. In this group, 42.9% received IRT and 78.6% were managed with supportive therapy. At 12-month follow-up, 28.6% required no further treatment, while 42.9% remained on IRT. Among patients with SSBB, 50% received supportive therapy, 41.7% were treated with long-acting SSA, and one required emergent transarterial embolization. At follow-up, 33.3% required no additional therapy, 25% remained on IRT, two patients received SSA as bridge therapy to valvular replacement, and two continued long-acting SSA long-term.

In healthcare settings where device-assisted enteroscopy is not readily available, management of small-bowel angiodysplasias relies primarily on supportive measures, iron supplementation, transfusion support, optimization of antithrombotic therapy, and selective use of long-acting SSA. In this real-world single-center cohort, both IDA and SSBB patients demonstrated meaningful clinical improvement over 12 months, with a considerable proportion requiring no further intervention. Long-acting SSA appeared particularly beneficial in patients with recurrent bleeding and significant cardiovascular comorbidities, either as monotherapy or as bridging therapy until valvular replacement.