Early double-balloon enteroscopy was not related to better clinical outcomes in patients with suspected overt small bowel bleeding

Abstract

Background: Device-assisted enteroscopy has been used for over 20 years for the management of patients with suspected small bowel bleeding. Unlike esophagogastroduodenoscopy and colonoscopy, the appropriate timing of enteroscopy is still unknown. In recent guidelines, early enteroscopy is suggested to maximize diagnostic yield and therapeutic yield in patients with suspected small bowel bleeding. However, few studies have identified its influence on clinical outcomes, including mortality or rebleeding rate. We conducted this study to evaluate the influence of the timing of double-balloon enteroscopy on clinical outcomes in patients with suspected small bowel bleeding. Methods: Patients with overt small bowel bleeding who underwent double-balloon enteroscopy from January 2013 to February 2021 were retrospectively reviewed. Patients were categorized into an early enteroscopy group (≤14 days) and a nonearly enteroscopy group (> 14 days). Clinical outcomes, including short-term mortality and rebleeding rate, long-term mortality and rebleeding rate, diagnostic yield and therapeutic yield, were analyzed. Results: A total of 100 patients (mean age, 66.2 years; 53% male) were included, and 44 patients were stratified into the early enteroscopy group. The diagnostic yield, therapeutic yield, mortality, and rebleeding rate were similar between two groups. In multivariate conditional logistic regression analysis, there were no significant differences between two groups regarding the 30-day rebleeding rate (adjusted odds ratio [aOR], 1.43; 95%CI, 0.47-4.33), 90-day rebleeding rate (aOR, 1.18; 95%CI, 0.47-2.94), 30-day mortality rate (aOR, 1.29; 95%CI, 0.21-8.13), 90-day mortality rate (aOR, 1.94; 95%CI, 0.48-7.87) and 90-day bleeding-related mortality (aOR, 2.18; 95%CI, 0.24-19.52). The Kaplan‒Meier survival curve analysis showed that the timing of DBE was not associated with the long-term rebleeding rate or mortality rate (p=0.57 and 0.83, respectively). Conclusion: The timing of enteroscopy did not influence the clinical outcomes, including the short-term mortality rate, short-term rebleeding rate, long-term mortality rate and rebleeding rate, in patients with suspected overt small bowel bleeding.