Clinical Significance of Double-Balloon Enteroscopy for Small Intestinal Bleeding

Abstract

Background and Aim: It had been extremely difficult to observe the entire small intestine by endoscopy until the emergence of wireless capsule endoscopy (CE) or double-balloon enteroscopy (DBE). To assess the usefulness of DBE in patients with suspected small intestinal bleeding, the cases before and after the introduction of DBE to our hospital were compared retrospectively in their diagnoses and treatments. Methods: Twenty consecutive patients with suspected small intestinal bleeding underwent enteroscopy using double-balloon technique between September 2003 and November 2005 in Tokai University Hospital (Group A). Two patients were subsequently excluded owing to being diagnosed as bleeding from a diverticulum or an angiodysplasia in the ascending colon. For comparison, inpatients with colonoscopy and gastroscopy negative gastrointestinal bleeding in Tokai University Hospital from May 1998 to August 2003 were reviewed and 27 consecutive cases without DBE were selected as a control group (Group B). All patients selected in this study had undergone more than one colonoscopy and gastroscopy that was negative for a source of bleeding. Results: There were no significant differences between the 2 groups in terms of age, gender, history of blood transfusion, blood hemoglobin value on admission, or symptom. The diagnostic yields of DBE in identifying the source of bleeding were 83.3% including 6 cases of angiodysplasia, 6 of small intestinal ulcers, 1 of arteriovenous(A-V) malformation and 2 of submucosal tumor (SMT). Besides, 3 of the 6 angiodysplasia cases were successfully treated by argon plasma coagulation using DBE. As for the control group, conventional approaches including enteroclysis, angiography, Meckel scan, scintigraphy with technetium labeled red blood cells, and/or push enteroscopy were performed in 88.9%, 29.6%, 29.6%, 55.6%, 25.9% of the cases, respectively. The overall diagnostic yields of the conventional approaches were only 11.1% (p < 0.01) including a Meckel's diverticulum, a polyp or an angiodysplasia. There were no severe complications attributed to the examinations in either of the groups during the procedures. Conclusion: For the patients with suspected small intestinal bleeding, DBE is a very useful procedure in the diagnosis and also effective in the treatment in some cases such as angiodysplasia.