30-Month Follow-Up After Double Balloon Enteroscopy in Patients with Obscure Gastrointestinal Hemorrhage

Abstract

Background: Double Balloon Enteroscopy (DBE) is a useful endoscopic modality for diagnosis and treatment of small bowel abnormalities responsible for obscure gastrointestinal bleeding. Long-term outcomes after DBE have not been extensively published. Methods: We invited patients who had undergone DBE for obscure GI bleeding between 8/04-9/06 to participate. We contacted patients via phone in 11/06 and 11/08 in order to collect information regarding recurrent bleeding, need for transfusions, subsequent procedures, and need for iron therapy since the initial DBE examination. Results: We invited 274 patients to participate in the study; 135 (49%) patients agreed to participate with a mean (±SD) age of 64 ± 14.8 (range 23-90) years. For the first phase of the study, 101 (37%) patients were contacted with a mean follow-up time post-DBE of 10.5 ± 5 (range 2-26) months. The most common findings on DBE examination were AVMs found in 50 (43%) of patients during the anterograde approach. Recurrent or persistent anemia occurred in 34 (31%) patients: 14 (41%) had persistent anemia requiring transfusions and/or iron therapy, while 20 (59%) had ongoing overt bleeding. In the 32 patients with subsequent procedures post-DBE, AVMs were found in 8 (25%). Fifty-eight patients were subsequently contacted in 11/08 for a mean follow-up of 30 ± 7.3(range 18-47) months. The findings from the DBE examinations in these 58 patients included normal mucosa in 30 (52%), AVMs in 16(27.5%), inflammatory mucosa in 3, and other findings including Dieulafoy lesion (1), blue rubber nevus (1), lymphangiectasia (1), Meckel's diverticulum (1), ulcerations (3), and paraesophageal hernia (1). Six patients died of causes not related to bleeding. Recurrent bleeding occured in 12/52 (23%). Recurrent bleeding occured in 6 patients with normal DBE, 3 with AVMs, and in 4 other patients (1 blue rubber nevus, 1 radiation enteritis, 1 portal hypertensive enteropathy, 1 untreated Crohn's patient). 5 patients underwent repeat DBE, 4 small bowel resection, 1 surgical shunt, and 1 valve replacement. 7 patients received transfusions and 12 remained on iron therapy. Conclusions: 30 months post-DBE for obscure GI bleeding, the majority of patients (67%) who were contacted did not have recurrent bleeding, require transfusions or iron therapy. Patients with normal initial DBE examinations or AVMs were most likely to experience recurrent bleeding.