Recurrent intestinal bleeding treated by double-balloon endoscopy in haemodialysis patients

Gastrointestinal (GI) bleeding is a common and troublesome complication of end-stage renal disease (ESRD). Patients often have various lesions in the small bowel and in either upper or lower GI tracts. Recently developed double-balloon endoscopy (DBE) enables observation of the entire small intestine through a combination of anterograde and retrograde approaches. Moreover, DBE is useful not only for diagnosis of small intestinal lesions; it provides a mode of treating the disease. This article presents patients with several small intestinal diseases from our facility. Their bleeding sources were identified using DBE. We also report two representative cases of angiodysplasia that had been diagnosed and treated successfully using DBE. One case particularly underscored the usefulness of the combination of capsule endoscopy (CE) and DBE as an electively diagnostic approach for patients with GI bleeding. Small intestinal bleeding is often observable repeatedly in a single patient, as described for case 1. In such circumstances, DBE can treat the lesions successfully without surgical procedures. In this report, ESRD patients, in whom comorbid conditions made it difficult to perform surgical procedures, receive great benefit from DBE.