A Retrospective Review of Enteroclysis in Patients with Obscure Gastrointestinal Bleeding and Chronic Abdominal Pain of Undetermined Etiology

Abstract

Our purpose was to determine the diagnostic utility of enteroclysis in the evaluation of obscure gastrointestinal bleeding and abdominal pain of unknown etiology. This is a retrospective review of 97 consecutive patients (mean age, 54.1+/-17.5 [SD] years; 49 male and 48 female) who underwent enteroclysis at Temple University Hospital from January 1994 to October 2001 for the evaluation of obscure GI bleeding or chronic abdominal pain of undetermined etiology. Prior to enteroclysis all patients had an EGD and colonoscopy, which were nondiagnostic for their symptoms. Sixty-three patients (64.9%) had enteroscopy performed prior to enteroclysis that was also negative. Enteroclysis results were defined as positive based on anatomical or functional abnormalities. Analysis of the data included the percentage yield of positive exams, the percentage of positive results per symptom category, and the percentage of patients with a change in clinical management based on positive enteroclysis results. Ninety-seven patients underwent enteroclysis. The indications for enteroclysis were obscure GI bleeding in 67 patients (69.1%) and chronic abdominal pain in 30 patients (30.9%). The number of positive exams was 19 (19.6%). Fourteen of the 67 patients with the indication of GI bleeding had a positive exam (21%), while 5 of the 30 patients with chronic abdominal pain had a positive result (16.7%). There was a change in clinical management due to the enteroclysis results in 10 patients: 7 patients with GI bleeding (10%) and 3 patients with chronic abdominal pain (10%). Positive enteroclysis findings included adhesions (7), filling defects and masses (5), strictures (2), small bowel diverticulosis (1), mucosal abnormalities (3), and a motility disorder (1). The overall positive yield for enteroclysis was 19.6%, with a yield of 16.7% for chronic abdominal pain and 21% for gastrointestinal bleeding. Enteroclysis results changed the clinical management in approximately 10% of the patients.

Enteroclysis: Current clinical value

“…Taking into account that in this patient population enteroclysis stands at the end of the diagnostic chain these are satisfactory results which are consistent with the data of other research groups and justify the use of enteroclysis [24][25][26][27] . None the less investigation of gastrointestinal bleeding remains the domain of endoscopy.…”

“…In particular the high number of detected pathologies in the latter group differs significantly from previous results. In patients with unclear abdominal complaints Lankisch et al [31] and Malik et al [27] detected 6% and 16.7% pathological findings by enteroclysis. The high percentage of detected pathologies in this study may be explained by the fact that 63.2% of the referrals were with suspected small bowel obstruction.…”

“…This illustrates impressively the correlation of an exact clinical indication and the efficiency of the used radiological procedure. If the radiological findings stay inconspicuous, the use of video capsule endoscopy provides no diagnostic gain: In 20 patients with unexplained abdominal pain and normal upper gastrointestinal endoscopy, colonoscopy, push-enteroscopy and radiological workup, Bardan et al [27] detected no pathology using video capsule endoscopy.…”

Gastroenterologic and Radiologic Approach to Obscure Gastrointestinal Bleeding: How, Why, and When?

“…The role of small bowel series and conventional enteroclysis in the evaluation of OGIB has declined substantially with the advent of newer imaging techniques owing to the low diagnostic yield of the former two techniques (10). Available data suggest that unless malignancy or Crohn disease is suspected, small bowel series and conventional enteroclysis have little use in the evaluation of OGIB (4).…”

Capsule enteroscopy and radiology of the small intestine

“…In patients with OGIB, VCE has a calculated incremental yield over push enteroscopy and small bowel barium radiology for clinically significant findings of ≥30%, mainly ascribed to visualization of additional vascular and inflammatory lesions by VCE (22). However, small bowel radiology still results in a change in clinical management in approximately 10% of patients, although its overall positive yield may be less than 20% (30).…”