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Evaluation of the Effectiveness of Longitudinal Incision for Endoscopic Submucosal Excavation of Gastric Subepithelial Lesions
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Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding

Hoi-Poh Tee1, Arthur J Kaffes

  • 1A W Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown Rd, Sydney 2050, Australia.

World Journal of Gastroenterology
|April 17, 2010
PubMed

Insights

Double-balloon enteroscopy (DBE) identified non-small-bowel lesions in 24.6% of obscure gastrointestinal bleeding patients, with vascular lesions frequently missed by prior endoscopies. Repeat conventional endoscopy may be beneficial.

Area of Science:

  • Gastroenterology
  • Endoscopy
  • Diagnostic Imaging

Background:

  • Obscure gastrointestinal bleeding (OGIB) presents a diagnostic challenge.
  • Double-balloon enteroscopy (DBE) is a key tool for investigating OGIB.
  • Non-small-bowel lesions (NSBLs) can contribute to OGIB but may be missed by standard endoscopic evaluations.

Purpose of the Study:

  • To determine the incidence of NSBLs during DBE procedures for OGIB.
  • To analyze the diagnostic significance of NSBLs identified by DBE.
  • To evaluate the rate of newly diagnosed NSBLs in patients undergoing DBE.

Main Methods:

  • Retrospective analysis of a prospective DBE database from a tertiary referral center.
  • Inclusion of 179 patients with OGIB undergoing DBE between June 2004 and November 2008.
  • Assessment for the incidence of all and newly diagnosed NSBLs during DBE procedures.

Main Results:

  • A total of 228 DBE procedures were performed in 179 patients.
  • The overall positive yield for a bleeding lesion was 65.9%.
  • Non-small-bowel lesions (NSBLs) were identified in 24.6% of patients, with 15.1% representing newly diagnosed lesions, most commonly vascular lesions.

Conclusions:

  • A significant proportion of OGIB patients (24.6%) harbor lesions amenable to conventional endoscopy.
  • Vascular lesions were frequently among the missed diagnoses in patients undergoing DBE.
  • Careful consideration of repeat gastroscopy and colonoscopy is warranted for patients with OGIB, especially when NSBLs are suspected.
Abstract

Keywords:
BleedingDouble-balloon enteroscopyEndoscopyObscure gastrointestinal bleeding

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