Multicenter survey on the use of device‐assisted enteroscopy in Portugal

Abstract

Background: Device-assisted enteroscopies (DAEs) are recent endoscopic techniques that enable direct endoscopic smallbowel evaluation. Objective: The objective of this article is to evaluate the implementation of DAEs in Portugal and assess the main indications, diagnoses, diagnostic yield, therapeutic yield and complication rate. Methods: We conducted a multicenter retrospective series using a national Web-based survey on behalf of the Portuguese Small-Bowel Study Group. Participants were asked to fill out two online databases regarding procedural data, indications, diagnoses, endoscopic therapy and complications using prospectively collected institutional data records. Results: A total of eight centers were enrolled in the survey, corresponding to 1411 DAEs. The most frequent indications were obscure gastrointestinal bleeding (OGIB), inflammatory bowel disease and small-bowel tumors. The pooled diagnostic yield was 63%. A relation between the diagnostic yield and the indications was clear, with a diagnostic yield for OGIB of 69% (p ¼ 0.02) with a 52% therapeutic yield. Complications occurred in 1.2%, with a major complication rate of 0.57%. Perforations occurred in four patients (0.28%). Conclusion: DAEs are safe and effective procedures, with complication rates of 1.2%, the most serious of which is perforation. Most procedures are performed in the setting of OGIB. Diagnostic and therapeutic yields are dependent on the indication, hence appropriate patient selection is crucial.

Multicentre European study of double balloon enteroscopy for small bowel pathology in patients with cardiovascular disease

“…We have also found that patients with cardiovascular disease have a higher diagnostic and therapeutic yield. Vascular angioectasia was also the commonest finding in patients with OGB, as previously reported in the literature [1,2]. We feel that DBE should be carefully considered in patients with OGB even with the presence of significant cardiovascular disease prior to the decision of medical therapy.…”

“…The authors suggest that anterograde DBE may be the most cost-effective approach in the evaluation and treatment of elderly patients with OGB and vascular lesions. A large proportion of patients with OGB are not only elderly but with significant comorbidity, particularly cardiovascular disease [2]. Pasha et al also elude that although medical therapy has not been proven to be effective for the management of small bowel bleeding, it is reserved for patients with significant comorbidity [1].…”

High short-term rebleeding rate in patients undergoing a second endoscopic therapy for small-bowel angioectasias after recurrent bleeding

“…In Western countries, SBVL represent the most frequent small bowel finding in patients with OGIB (10). (3) The exact prevalence of angioectasias is unclear because most patients are asymptomatic and only 10% of all patients will experience a symptomatic gastrointestinal bleed during their lifetime (13,17,18). (5,7,11) The clinical presentation of angioectasias includes overt bleeding or iron deficiency anemia, which represent the main indications for endoscopic treatment (3,13,19,20).…”

“…Other reports suggest a reduction in rebleeding rates in patients who received additional therapy. This is probably as a result of intensive enteroscopy and increased complete enteroscopy rates, which may allow the treatment of SBVL that were not reached in previous examinations as there were multiple lesions occurring throughout the gastrointestinal tract (15,18,21,22).…”

Refractory Anaemia Secondary to Small Bowel Angioectasias - Comparison between Endotherapy Alone versus Combination with Somatostatin Analogues

“…The diagnostic and therapeutic yield of device-assisted enteroscopy for OGIB was J Gastrointestin Liver Dis, December 2017 Vol. 26 No 4: 369-374 reported to be 69% and 52% in a multi-centre retrospective study [13]. The presence of an overtube at DBE allows deeper examination of the small bowel.…”