Two way push videoenteroscopy in investigation of small bowel disease

Abstract

Aims-To evaluate the diagnostic yield and safety of a new push type videoenteroscope (PVE) for diagnosis of small bowel disease. Methods-Three hundred and thirteen patients were referred for one or two way PVE from December 1993 to June 1996. Indications for PVE were: an unexplained iron deficiency anaemia with or without clinically evident gastrointestinal bleeding; or a complementary investigation for suspected small bowel disease, after a small bowel barium follow through (SBBFT) considered as normal or abnormal, but without a definite diagnosis. Results-A jejunoscopy and a retrograde ileoscopy were carried out in 306 and 234 patients, respectively. In patients with isolated anaemia (n=131) and those with clinically evident gastrointestinal bleeding associated anaemia (n=72), PVE provided a diagnosis in 26 (19.8%) and 22 (30.5%) cases, respectively. Lesions found were located in the jejunoileum in 30 (14.7%) patients and in the gastroduodenum or the colon in 18 (8.8%) patients-that is, within the reach of the conventional gastroscope/ colonoscope. In patients with normal (n=54) or abnormal (n=56) SBBFT, PVE provided a diagnosis in 17 (31%) and 27 (48%) cases, respectively. In 25% of cases, the abnormal appearance of SBBFT was not confirmed. The site of the radiological abnormality was not reached in 27% of cases. Lesions were located at the jejunum and the ileum in 59 (64%) and 33 (36%) cases, respectively. Conclusions-PVE is useful in around 30% of cases of unexplained anaemia or after an SBBFT which failed to provide an accurate aetiological diagnosis. Use of retrograde videoenteroscopy increases diagnostic yield by one third. (Gut 1998;43:280-284)

A Prospective Study on Evaluating the Diagnostic Yield of Video Capsule Endoscopy Followed by Directed Double-Balloon Enteroscopy in Patients with Obscure Gastrointestinal Bleeding

“…Moreover, biopsy and therapeutic intervention are not available with this diagnostic method. Push enteroscopy has been employed to detect small-bowel lesions, and it has the advantage of achieving both biopsy and therapy [11,12]. However, the success rate of reaching distal jejunal and ileal lesions is low [13][14][15].…”

Digestive hemorrhages of obscure origin

“…Yet small bowel hemorrhages there are well-known obstacles that make it dicult to provide a timely and accurate diagnosis because this tract cannot be explored optimally by endoscopic techniques [2,3].…”

“…Also, enteroscopy during laparoscopy may be necessary when laparoscopic exploration yields negative results [2]. Finally, in the case of small intestine hemorrhage, laparoscopy allows a meticulous exploration of the bowels, as well as simultaneous diagnosis and laparoscopic or video-assisted surgical treatment [11].…”

Capsule enteroscopy and radiology of the small intestine

“…In the pre-capsule era, the diagnostic work-up in patients with unexplained iron-deficiency anaemia included radiology of the small bowel, most often conducted as a tube enteroclysis or dedicated single contrast enterography, with a diagnostic yield of 10% to 20% only (61). The documented increase in diagnostic yield after the introduction of the VCE in 2001, resulted in its rapid clinical acceptance for investigation of patients with recurrent gastrointestinal bleeding of obscure origin, primarily in those with negative small bowel barium enema studies (62), gastroscopy and colonoscopy (51).…”