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Predictors of double balloon endoscopy outcomes in the evaluation of gastrointestinal bleeding
Hisham Hussan1, Nicholas R Crews1, Caroline M Geremakis1
1Hisham Hussan, Section of Intestinal Neoplasia and Hereditary Polyposis (INHP), Department of Gastroenterology, Hepatology and Nutrition, The Ohio State University Medical Center, Columbus, OH 43210, United States.
Insights
Predicting outcomes for double balloon endoscopy (DBE) in obscure gastrointestinal bleeding (OGIB) is crucial. Patient factors like transfusion history and prior endoscopic findings significantly influence DBE diagnostic yield and therapeutic success.
Area of Science:
- Gastroenterology
- Endoscopy
- Digestive Diseases
Background:
- Obscure gastrointestinal bleeding (OGIB) presents a diagnostic challenge.
- Double balloon endoscopy (DBE) is a key tool for investigating OGIB.
- Identifying factors influencing DBE outcomes can optimize its use.
Purpose of the Study:
- To determine patient characteristics associated with the outcomes of double balloon endoscopy (DBE).
- To analyze factors affecting diagnostic yield and therapeutic intervention in DBE for OGIB.
Main Methods:
- Retrospective study at an academic tertiary referral center.
- Evaluation of clinical factors linked to non-diagnostic or non-therapeutic DBE procedures for OGIB.
- Analysis of 55 DBE procedures performed between August 2010 and April 2012.
Main Results:
- Non-diagnostic yield was associated with multiple DBEs per day, no recent blood transfusions, and absence of prior ulcer/AVM findings.
- Non-therapeutic intervention correlated with multiple DBEs per day, recent bleeding, fewer prior transfusions, and absence of prior ulcer/AVM findings.
- Performing multiple DBEs daily was a strong predictor for both non-diagnostic and non-therapeutic outcomes.
Conclusions:
- Blood transfusion requirements and prior endoscopic findings are key predictors of DBE success.
- Potential factors like endoscopist fatigue may also impact DBE outcomes.
- These findings can help refine patient selection and procedural planning for DBE in OGIB.
Aim:
To identify patients' characteristics associated with double balloon endoscopy (DBE) outcomes in investigation of obscure gastrointestinal bleeding (OGIB).
Methods:
Retrospective study performed at an academic tertiary referral center. Evaluated endpoints were clinical factors associated with no diagnostic yield or non-therapeutic intervention of DBE performed for OGIB evaluation.
Results:
We included fifty-five DBE between August 2010 and April 2012. The mean age of the sample was 67 with 32 males (58.2%). Twenty-four DBE had no diagnostic yield and 30 DBE did not require therapy. Non-diagnostic yield was associated with performing two or more DBE studies in one day [odds ratio (OR): 13.72, P = 0.008], absence of blood transfusions within a year of the DBE (OR: 7.16, P = 0.03) and absence of ulcers or arteriovenous malformations (AVMs) on prior esophagogastroduodenoscopy (EGD) or colonoscopy (OR: 19.30, P = 0.033). Non-therapeutic DBE was associated with performing two or more DBE per day (OR: 18.579, P = 0.007), gastrointestinal bleeding episode within a week of the DBE (OR: 11.48, P = 0.003), fewer blood transfusion requirements prior to DBE (OR: 4.55, P = 0.036) and absence of ulcers or AVMs on prior EGD or colonoscopy (OR: 8.47, P = 0.027).
Conclusion:
Predictors of DBE yield and therapeutic intervention on DBE include blood transfusion requirements, previous endoscopic findings and possibly endoscopist fatigue.
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