| Double-balloon enteroscopy following capsule endoscopy in the management of obscure gastrointestinal bleeding: outcome of a combined approach. | |
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MedLine Citation:
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PMID: 18478135 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: There is no consensus on the relative accuracy of capsule endoscopy (CE) versus double-balloon enteroscopy (DBE) to investigate obscure gastrointestinal bleeding (GIB). CE is less invasive, but DBE more directly examines the small bowel, and allows tissue sampling plus therapeutic intervention. OBJECTIVES: To evaluate the yield and outcome of DBE following CE in patients with obscure GIB. METHODS: After DBE became readily available at the Centre for Therapeutic Endoscopy and Endoscopic Oncology (St Michael's Hospital, Toronto, Ontario), all patients with obscure GIB seen from December 2002 to June 2007 were evaluated identically, first with CE, then with DBE (some with further interventions). Findings, adverse outcomes and interventions are reported. RESULTS: Fifty-one patients (25 women) with a mean (range) age of 64.1 years (34 to 83 years) are reported. Eight patients underwent DBE twice, for a total of 59 DBEs. Fourteen patients had overt GIB and the median (range) number of red blood cell unit transfusions was 10 (0 to 100). The positive findings for each type of lesion were compared in these 51 patients: angiodysplasia (CE 64.7% and DBE 61%, P=0.3), ulcers (CE 19.6% and DBE 18.6%, P=0.5), bleeding lesions (CE 43.1% and DBE 15.3%, P=0.0004) and mass (CE 10.2% and DBE 8.5%, P=0.5). DBE provided the advantage of therapeutic intervention: argon plasma coagulation (33 of 59 DBEs), clipping (two of 59), both argon plasma coagulation and clipping (three of 59), polypectomy (two of 59), tattooing (52 of 59) and biopsies (11 of 59). DBE detected lesions not seen by CE in 21 patients; lesions were treated in 18 patients. However, CE detected 31 lesions not seen by DBE. No major complications occurred with either examination. CONCLUSION: Overall detection rates for both techniques are similar. Each technique detected lesions not seen by the other. These data suggest that CE and DBE are complementary and that both evaluate obscure GIB more fully than either modality alone. |
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Authors:
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Patarapong Kamalaporn; Sarah Cho; Nancy Basset; Maria Cirocco; Gary May; Paul Kortan; Gabor Kandel; Norman Marcon |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Canadian journal of gastroenterology = Journal canadien de gastroenterologie Volume: 22 ISSN: 0835-7900 ISO Abbreviation: Can. J. Gastroenterol. Publication Date: 2008 May |
Date Detail:
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Created Date: 2008-05-14 Completed Date: 2008-10-22 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 8807867 Medline TA: Can J Gastroenterol Country: Canada |
Other Details:
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Languages: eng Pagination: 491-5 Citation Subset: IM |
Affiliation:
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Centre for Therapeutic Endoscopy and Endoscopic Oncology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. patarakamala@yahoo.com |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Balloon Occlusion* Capsule Endoscopy* Cohort Studies Female Gastrointestinal Hemorrhage / diagnosis*, therapy* Humans Intestinal Diseases / diagnosis*, therapy* Male Middle Aged Predictive Value of Tests Retrospective Studies Treatment Outcome |
| Comments/Corrections | |
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