The Outcome Assessment of Double-Balloon Enteroscopy for Diagnosing and Managing Patients with Obscure Gastrointestinal Bleeding

Abstract

Diagnosing and treating patients with obscure gastrointestinal bleeding is clinically challenging. Most lesions responsible for the origin of obscure gastrointestinal bleeding are located in the small bowel. Double-balloon enteroscopy is a novel method for exploring the small intestine and has significant therapeutic potential. This study evaluated the value of double-balloon enteroscopy in diagnosing and managing obscure gastrointestinal bleeding. From October 2003 to January 2006, a total of 20 patients (6 men, 14 women; mean age, 55.2 years old) with obscure gastrointestinal bleeding (18 obscure overt bleeding, 2 obscure occult bleeding) were investigated by double-balloon enteroscopy. A total of 29 procedures (15 via oral approach and 14 via rectal approach) were performed. The diagnostic yield, endoscopic therapeutic procedures, complications, and outcome were then assessed. Small bowel lesions potentially responsible for the bleeding were identified in 15 (75%) of 20 patients, including 9 angiodysplasias, 2 gastrointestinal stromal tumors (GISTs), 2 ulcers, 1 jejunal granulation polyp, and 1 Peutz-Jeghers polyposis. Endoscopic treatments including heater probe coagulation, polypectomy, and endoscopic mucosal resection were performed in 11 patients. Two patients with GISTs received surgical intervention. Two patients with angiodysplasias that endoscopic treatment failed underwent laparoscopic resections following tattooing. There were no complications and the procedures were tolerated well. Among the 15 patients who had a lesion identified with subsequent treatment, rebleeding occurred in 3 (20%) patients with angiodysplasias. Of the five patients in whom no definite lesion was detected, rebleeding developed in four (80%). For patients with an identified lesion that was further treated, the rebleeding rate was lower than for those with "persistent" obscure gastrointestinal bleeding (P=0.031). We conclude that double-balloon enteroscopy offers a safe and effective method for diagnosing and managing patients with obscure gastrointestinal bleeding.

Evaluation and outcomes of patients with obscure gastrointestinal bleeding

“…Seventy-seven percent of patients maintained a normal haemoglobin. Hsu et al [59] similarly found significantly less rebleeding in patients who were treated for an identified lesion when compared to patients in whom no lesion was found (20% vs 80%).…”

“…It is considered the gold standard for therapeutic intervention of many small bowel disorders in OGIB [49] . The diagnostic yield and treatment success of DBE for OGIB in published literature ranges from 60%-81% and 43%-84% respectively [10,[50][51][52][53][54][55][56][57][58][59][60] . The variation in diagnostic yield is a result of differences in DBE timing, inclusion criteria and definitions of a significant finding [61] .…”

Laparoscopically assisted bowel surgery in an era of double-balloon enteroscopy: from inside to outside

“…Temporary endoscopic hemostasis for surgical candidates to avoid emergency operation is another application of DBE [15,16]. Staged surgical intervention after DBE offers critically ill patients an invaluable period during which blood transfusion, fluid and electrolyte supplementation, nutritional support, correction of underlying medical diseases, and supplementary workup can be performed.…”

“…Both the enteroscopic device and the double-balloon technique, which allows the small bowel to be threaded onto the overtube, has been described in detail elsewhere [15,16]. The insertion route was determined by the endoscopists based on the clinical presentation and the results of previous investigations.…”

Treatment Decision for Potential Bleeders in Obscure Gastrointestinal Bleeding During Double-Balloon Enteroscopy

“…In published studies, doubleballoon enteroscopy has displayed superior diagnostic yield and therapeutic power for obscure gastrointestinal bleeding [1,16]. The primary aim of this study is to assess the diagnostic and therapeutic yield in obscure gastrointestinal bleeding.…”