Document Detail

Double-balloon enteroscopy following capsule endoscopy in the management of obscure gastrointestinal bleeding: outcome of a combined approach.
MedLine Citation:
PMID:  18478135     Owner:  NLM     Status:  MEDLINE    
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.
Patarapong Kamalaporn; Sarah Cho; Nancy Basset; Maria Cirocco; Gary May; Paul Kortan; Gabor Kandel; Norman Marcon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
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:
Created Date:  2008-05-14     Completed Date:  2008-10-22     Revised Date:  2014-01-17    
Medline Journal Info:
Nlm Unique ID:  8807867     Medline TA:  Can J Gastroenterol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  491-5     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Balloon Occlusion*
Capsule Endoscopy*
Cohort Studies
Gastrointestinal Hemorrhage / diagnosis*,  therapy*
Intestinal Diseases / diagnosis*,  therapy*
Middle Aged
Predictive Value of Tests
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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