Push-enteroscopy series: diagnostic and therapeutic efficacy

To analyse the diagnostic efficacy of oral push-type enteroscopy (PE) according to indications. To assess evolution in patients with occult gastrointestinal bleeding (OGIB) according to findings and endoscopic therapy.

204 PE performed in 167 patients: OGIB: 117, Crohn's disease: 34, radiological abnormalities: 21; chronic diarrhoea: 12; intestinal sub-occlusion: 11; polyposis: 7; other: 2. We followed clinical outcome in 72 patients after PE for OGIB. They were separated according to findings and endoscopic therapy: no findings: 32; no treated angiodysplasia: 10; treated angiodysplasia: 20; other lesions: 10. We evaluated the number of admissions and transfusional requirements before and after PE, re-bleeding and surgical treatment. Statistics were performed using Student's t test and Chi-square test (statistical significance p < 0.05).

We diagnosed lesions in 65.8% PE for OGIB, angiodysplasia being the more frequent finding (33.3%). We found lesions before Treitz in 15.4% A higher diagnostic efficacy was seen in active bleeding (83.4%) versus anaemia (52.2%), p < 0.05. After PE both admissions and transfusional requirements decreased in all subgroups specially in treated angiodysplasias and other lesions, nearly reaching statistical significance (p = 0.07). Re-bleeding occurred in 50% of non-treated lesions versus 20-25% in treated lesions. We found lesions in 47% of PE for Crohn's disease, in 52.4% for radiological abnormalities, in 41.6% for chronic diarrhoea and in 0% for intestinal sub-occlusion.

PE is efficient in the diagnosis and therapy of patients with OGIB, Crohn's disease and radiological abnormalities. Its usefulness is controversial in the study of chronic diarrhoea and intestinal sub-occlusion.