Predictors for outcomes and readmission rates following double balloon enteroscopy: a tertiary care experience

Abstract

Aim The objectives of this study are to examine clinical characteristics of patients undergoing anterograde and retrograde double balloon enteroscopy (DBE) and to assess factors predicting positive diagnostic yield, therapeutic yield, and readmission. Methods We conducted a retrospective cohort study of patients (n = 420) who underwent DBE at a tertiary care center between 2012 and 2016 at a tertiary referral center. Measures of central tendency and frequency distributions were used for univariate analysis. Chi-square and t-test analyses were used to compare patient characteristics. Logistic regression was used to predict outcomes of interest. Results Of patients included in the study, 59 % were male with a mean age of 61.49 (SD = 15.15) Altered anatomy was noted in 14 %, while 5 % and 13 % of patients had end stage renal disease (ESRD) and current use of anticoagulation, respectively. The most common indication for DBE was obscure gastrointestinal bleed (OGIB) (33 %). Forty-nine patients had obscure and overt gastrointestinal bleeding (GIB) and 22 % had occult GIB with iron deficiency. The cohort’s rate of positive diagnostic yield was 73 % and 35 % for therapeutic yield. The 30-day and 6-month readmission rates were both 11 %. A higher proportion of those readmitted were male (75 % vs 57 %, P = 0.027) and had longer procedural time (38.68 vs 46.57, P = 0.011). Likewise, occult GIB with iron deficiency anemia and iron deficiency alone (OR = 2.45, CI: 1.233 – 4.859, P = 0.011), inpatient status (OR 2.42, CI 1.344 – 4.346, P = 0.003), and longer procedural time (OR = 1.02, CI: 1.004 – 1.029, P = 0.008) were associated positively with readmission. Conclusion DBE procedures have relevant efficacy for both diagnostic and therapeutic yield while evaluating small bowel disease. Readmission rates are low and more in those with GI bleed and iron deficiency with longer index procedural times.

Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases

“…Occult SBB patients usually visit hospitals for positive fecal occult blood tests or anemia caused by chronic gastrointestinal blood loss. 8,27 The diagnostic yield of DAE in occult SBB ranges from 52.4% to 75.0%, [28][29][30] which increases when DAE is performed after a positive CE. 29 The most frequently identified lesions are angioectasias, and occasionally, erosions, ulcers, and tumors.…”

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

“…186 In a retrospective single centre study of 420 patients undergoing double-balloon enteroscopy, it was noted that 13% were on anticoagulation. 187 Although the risk of bleeding may be low for diagnostic procedures, therapeutic procedure such as polypectomy would confer a high risk of haemorrhage on antithrombotics. Endoscopic therapy was performed in 47.1% of 257 double-balloon procedures in a UK case series.…”

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

“… 185 Double balloon enteroscopy is associated with a perforation rate of 0.1–0.4 % 183 186 and this rises to 1.5 % if polypectomy is performed 186 . In a retrospective single centre study of 420 patients undergoing double-balloon enteroscopy, it was noted that 13 % were on anticoagulation 187 . Although the risk of bleeding may be low for diagnostic procedures, therapeutic procedure such as polypectomy would confer a high risk of haemorrhage on antithrombotics.…”