Diagnosis and treatment of obscure GI bleeding at double balloon endoscopy

Ohmiya, Naoki; Yano, Tomonori; Yamamoto, Hironori; Arakawa, Daigo; Nakamura, Masanao; Honda, Wataru; Itoh, Akihiro; Hirooka, Yoshiki; Niwa, Yasumasa; Maeda, Osamu; Ando, Takafumi; Yao, Tsuneyoshi; Matsui, Toshiyuki; Iida, Mitsuo; Tanaka, Shinji; Chiba, Tsutomu; Sakamoto, Choitsu; Sugano, Kentaro; Goto, Hidemi

doi:10.1016/j.gie.2007.05.041

Cited by 145 publications

(139 citation statements)

References 16 publications

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“…Balloon-assisted enteroscopy is considered the second-line examination for patients with OGIB and positive findings in CE requiring further exploration or therapeutic intervention (10,27). However, the reported rates of total small bowel intubation vary widely (ranging from 0 to 86%), hampered by the presence of intestinal adhesions of previous surgery, obesity or with operators with less experience (19,20,23,25,(28)(29)(30). Nevertheless, when balloon enteroscopy approach is directed by CE findings, one-side procedure was sufficient to achieve the lesion in almost 90% of examinations (31).…”

Section: Discussionmentioning

confidence: 99%

Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

Monsanto¹,

Almeida²,

Lérias³

et al. 2012

Rev. esp. enferm. dig.

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Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20 th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding.Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years) submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively.Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleeding lesion in 94%. Small bowel findings included: angiodysplasia (n = 6), ulcers (n = 4), small bowel Dieulafoy's lesion (n = 2), bleeding from anastomotic vessels (n = 1), multiple cavernous hemangiomas (n = 1) and bleeding ectopic jejunal varices (n = 1). Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively.Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

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Section: Discussionmentioning

confidence: 99%

Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

Monsanto¹,

Almeida²,

Lérias³

et al. 2012

Rev. esp. enferm. dig.

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“…Some [18,20] reported angiodysplasia as a main cause of OGIB, while others [19,21] report ulcers to be the main etiology. However, when considered large studies that include more than 100 patients, one study from India [21] and two double-balloon enteroscopy studies from Japan [22,23] , all showed that small bowel ulcers were the most common cause of OGIB (41%-53%), more common than angiodysplasia (23%-24%). These yielding rates are much closer to the results of our study (44% and 27% for ulcers and angiodysplasia, respectively).…”

Section: Characteristics Of Patients According To the Etiologymentioning

confidence: 99%

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Pongprasobchai¹

2013

WJGE

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AIM:To investigate the yield, etiologies and impact of capsule endoscopy (CE) in Thai patients with obscure gastrointestinal bleeding (OGIB). METHODS:The present study is a retrospective cohort study. All patients with OGIB who underwent CE in Siriraj Hospital, Bangkok, Thailand during 2005-2009 were included in the study. All the patients' medical records and results of the CE videos were reviewed. CE findings were classified as significant, suspicious/equivocal and negative. Sites of the lesions were located to duodenum, jejunum, jejunoileum, ileum and diffuse lesions by the localization device of the CE. Impact of CE on the patients' management was defined by any investigation or treatment given to the patients that was more than an iron supplement or blood transfusion. Patients' outcomes (rebleeding, persistent bleeding, anemia or requirement of blood transfusion) were collected from chart reviews and direct phone interviews with the patients. RESULTS:Overall, there were 103 patients with OGIB included in the study. Mean age of the patients was 64 ± 16 years (range 9-88 years) and 57 patients (55%) were male. Types of OGIB were overt in 80 (78%) and occult in 23 patients (22%). The median time interval of CE after onset of OGIB was 10 d (range 1-180 d). The median time of follow-up was 19 mo (range 1-54 mo). Capsules reached caecum in 77 patients (74%) and capsule retention was found in 1 patient (1%). The diagnostic yield of CE revealed significant lesions in 37 patients (36%), suspicious/equivocal lesions in 15 patients (15%) and 51 patients (49%) had negative CE result. Among the significant lesions, the bleeding etiologies were small bowel ulcers in 44%, angiodysplasia in 27%, small bowel tumor in 13%, miscellaneous in 8% and active bleeding without identifiable causes in 8%. Patients with small bowel ulcers were significantly associated with the use of non-steroidal anti-inflammatory drugs (48%, P = 0.034), while patients with small bowel tumors were more commonly female (86%, P = 0.043) compared to the other etiologies. The rate of rebleeding, persistent bleeding or anemia in patients with positive, equivocal and negative CE results were 5%, 0% and 18%, respectively (P = 0.078). All the 9 patients with rebleeding after negative CE were subsequently found to be from hematologic disorders (4), colonic diverticulosis (2), colonic Dieulafoy's (1), hemorrhoid (1) and hemosuccus pancreaticus (1). Results of CE had a positive impact on the patients' management in 35% of the patients whose results were positive, but none on the patients whose results were equivocal or negative CE (P < 0.001). CONCLUSION:In Thai OGIB patients, CE had low yield and small bowel ulcer was most common. Positive CE impacted managements and outcomes. Negative CE caused low rebleeding.

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“…mucosal biopsy, argon plasma coagulation, snare polypectomy, injection therapy, tattooing, foreign body extraction and balloon dilatation. DBE plays an important role in the diagnosis and treatment of obscure gastrointestinal bleeding [3][4][5][6] , Crohn's disease [7][8][9][10] , celiac disease [11,12] , polyposis syndromes [13] and small bowel tumors. In the series published to date, complications solely related to the diagnostic procedure are rare [14][15][16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

Double balloon endoscopy associated pancreatitis: A description of six cases

Jarbandhan

Weyenberg²,

Veer

et al. 2008

WJG

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INTRODUCTIONSince its introduction in 2001 by Yamamoto [1] , double balloon endoscopy (DBE) has revolutionized both diagnostic and therapeutic small bowel endoscopy [2] . This technique allows (intervention) endoscopy of the complete small bowel (often in two sessions) with the possibility of carrying out interventions; e.g. mucosal biopsy, argon plasma coagulation, snare polypectomy, injection therapy, tattooing, foreign body extraction and balloon dilatation. DBE plays an important role in the diagnosis and treatment of obscure gastrointestinal bleeding [3][4][5][6] , Crohn's disease [7][8][9][10] , celiac disease [11,12] , polyposis syndromes [13] and small bowel tumors. In the series published to date, complications solely related to the diagnostic procedure are rare [14][15][16][17][18] . A recent retrospective multicenter survey indicates a complication rate of 0.8% in diagnostic procedures [16] . In that study, pancreatitis occurred in six of 2362 (0.3%) procedures and contributed to 46% of all complications after diagnostic DBE. Another recent study showed that an asymptomatic rise of serum amylase and lipase levels after antegrade DBE is frequently encountered [19] . Nevertheless, only a few patients develop the clinical picture of post-DBE pancreatitis. The reason for this remains unknown.This article presents an analysis of all DBE-related cases of pancreatitis identified prospectively from a recorded DBE-complication database of 603 procedures in a single center. RESULTS: This is the largest single-center study reporting on post-DBE pancreatitis prospectively. Six patients (1.0%) developed post-DBE pancreatitis, all after antegrade DBE. There was no association with gender, duration of the procedure or type of endoscope. The mean age was 51.9 years (range 25-78). Four patients had severe pancreatitis. Of these, two had inflammatory signs in the body-tail region, one had pancreatitis in the tail region, and the total pancreas was involved in one. MATERIALS AND METHODS From CONCLUSION:The incidence of post-DBE pancreatitis in our series is higher than previously reported. We found no relation with DBE-endoscope type. The inflammatory changes occurred in the body-tail region of the pancreas, suggesting that post-DBE pancreatitis is caused by repetitive mechanical strain on the pancreas.

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Diagnosis and treatment of obscure GI bleeding at double balloon endoscopy

Abstract: DBE was relatively safe and useful for diagnosis and treatment of OGIB. A spectrum of small-bowel diseases presenting with OGIB in Japan may be distinct from that in the Western world.

Cited by 145 publications

References 16 publications

Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding

Double balloon endoscopy associated pancreatitis: A description of six cases

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