Assessment of multi-modality evaluations of obscure gastrointestinal bleeding.
World J Gastroenterol. 2017 Jan 28;23(4):614-621
Authors: Law R, Varayil JE, WongKeeSong LM, Fidler J, Fletcher JG, Barlow J, Alexander J, Rajan E, Hansel S, Becker B, Larson JJ, Enders FT, Bruining DH, Coelho-Prabhu N
AIM: To determine the frequency of bleeding source detection in patients with obscure gastrointestinal bleeding (OGIB) who underwent double balloon enteroscopy (DBE) after pre-procedure imaging [multiphase computed tomography enterography (MPCTE), video capsule endoscopy (VCE), or both] and assess the impact of imaging on DBE diagnostic yield.
METHODS: Retrospective cohort study using a prospectively maintained database of all adult patients presenting with OGIB who underwent DBE from September 1(st), 2002 to June 30(th), 2013 at a single tertiary center.
RESULTS: Four hundred and ninety five patients (52% females; median age 68 years) underwent DBE for OGIB. AVCE and/or MPCTE performed within 1 year prior to DBE (in 441 patients) increased the diagnostic yield of DBE (67.1% with preceding imaging vs 59.5% without). Using DBE as the gold standard, VCE and MPCTE had a diagnostic yield of 72.7% and 32.5% respectively. There were no increased odds of finding a bleeding site at DBE compared to VCE (OR = 1.3, P = 0.150). There were increased odds of finding a bleeding site at DBE compared to MPCTE (OR = 5.9, P < 0.001). In inpatients with overt OGIB, diagnostic yield of DBE was not affected by preceding imaging.
CONCLUSION: DBE is a safe and well-tolerated procedure for the diagnosis and treatment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or MPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE.
PMID: 28216967 [PubMed - indexed for MEDLINE]