Outcomes of Double Balloon Enteroscopy for Managing Overt Small Bowel Bleeding

Abstract

<jats:title>Abstract</jats:title><jats:p> Background The commonest therapeutic indications for double balloon enteroscopy (DBE) includes removal of retained video capsules, dilatation of strictures, polypectomy, and managing obscure small bowel bleeding. We review our experience in managing active small bowel bleeding with DBE.</jats:p><jats:p> Methods A retrospective review was done for all the cases undergoing DBE from August 2017 to July 2019. Patient follow-up data was collected.</jats:p><jats:p> Results Among 25 cases with a median age of 46.8 (range 25–65 years), 17 males (68%) underwent DBE for suspected small bowel bleeding. The commonest presenting complaint was melena 19 (76%). The findings were positive (diagnostic yield) in 18 (72%) patients with an antegrade approach. Active bleeding was associated with Dieulafoy's lesion (n = 6), gastrointestinal stromal tumors (GIST) (n = 4), jejunal varices (n = 3), angioectasia (n = 3), and ulcer (n = 2), who then underwent successful intervention. The rest of the patients underwent both antegrade and retrograde approach but failed to immediately identify an alternative diagnosis. Mean (standard deviation [SD]) time taken for antegrade enteroscopy was 96.7 (15.3) mins and 67.8 (13.6) mins for retrograde enteroscopy. The median duration between the last bleeding episode and timing of DBE was 9 (range 6–15 hours). No major complications were seen during or immediately postprocedure.</jats:p><jats:p> Conclusion DBE is useful in identifying and treating active small bowel bleeding. Being invasive and time-intensive, it is easy to miss lesions and, therefore, needs appropriate expertise. DBE does appear to be relatively cheaper, with better patient acceptance and time saving.</jats:p>

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“…An article, "Outcomes of double balloon enteroscopy for managing overt small bowel bleeding," by Dalal et al 1 highlighted the role of double-balloon enteroscopy in the diagnosis and treatment of small bowel pathological conditions and how it reduces the need for immediate surgical interventions.…”

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“…[7] DBEs usually have a high diagnostic yield ranging from 68-78%. [6,11,12] By performing a DBE after VCE, the diagnostic yield has been shown to increase to roughly 90%. [11] With a relatively high diagnostic yield in tandem, as well as opportunity for therapeutic intervention, VCEs and DBEs have become the gold standard for diagnosing and treating small bowel disease, particularly a suspected bleed.…”

“…[6,11,12] By performing a DBE after VCE, the diagnostic yield has been shown to increase to roughly 90%. [11] With a relatively high diagnostic yield in tandem, as well as opportunity for therapeutic intervention, VCEs and DBEs have become the gold standard for diagnosing and treating small bowel disease, particularly a suspected bleed. [6] Despite the time and di culty of a DBE, this procedure has become essential in evaluating and managing small intestinal pathology.…”