4745 Clinical impact of push-enteroscopy:prospective study.

Abstract

The aim of this study was to evaluate the impact of PE on diagnostic and therapeutic patient management. Methods: Sixty-eight patients (41M, 27F, mean age 52 y) referred for PE were included in this ongoing prospective study between May 1998 and August 1999. Indications for PE were: overt GI bledding (n=32,47%)and isolated iron deficiency anemia (n=14, 21%) of unkown origin, small bowel radiological abnormalities (n=8, 12%), malabsorption and/or chronic diarrhea (n=9, 13%), other indications (n=5, 7%). Before the procedure, the requesting physicians were asked to fill out a questionnaire listing the theoretical patient management plans (diagnostic procedures and/or treatment) as PE would have not been available. One month after PE, the same physicians were asked about: 1) the diagnostic procedures performed after PE, 2) the final diagnostic, 3) the impact of PE regarding changes in diagnostic and therapeutic management. Results: Responses to the 2 questionnaires were obtained for 97% of patients. The diagnostic yield of PE was 35% (n=24). PE modified the diagnostic management in 40% (n=27) of patients and therapeutic management in 32% (n=22)(medical treatment 10 pts, endoscopic treatment 8 pts, surgery 4 pts). As a whole, PE had clinical implications (changes in the diagnostic and/or therapeutic management) in 54% (n=37) of patients. The clinical impact of PE was greater in case of overt intestinal bleeding (56% of patients) than in isolated iron deficiency anemia (36% of patients). Updated data will be presented at the meeting. Conclusion: PE is perceived as useful by requesting physicians. Changes in management plan occurred in more than half of the patients explored by PE when diagnostic yield was 35%.