Diagnostic Yields and Outcomes of Treatment in Patients with Obscure Gastrointestinal Bleeding Using Double-Balloon Endoscopy

Abstract

Background and Aims: GI bleeding is a common disorder and source of bleeding cannot be identified with conventional EGD and colonoscopy in about 5% of the patients. We developed double-balloon endoscopy (DBE), a novel technique capable of accessing entire small intestine and evaluated diagnostic/therapeutic availability and clinical outcomes of DBE for obscure gastrointestinal bleeding. Methods: For 123 patients, 178 DBE examinations were performed between Sep. 2000 and Mar. 2004 at Jichi medical school hospital, Tochigi, Japan, and sixty-six consecutive patients who had obscure gastrointestinal bleeding were followed up. Conventional EGD and colonoscopy prior to DBE showed no potential source of bleeding in these patients. 57 patients had overt gastrointestinal bleeding and 9 patients had occult gastrointestinal bleeding, and diagnostic yield, therapeutic effectiveness, and outcomes of these two groups were analyzed. Patients were followed-up for 164 days on the average after the first DBE examination. Results: Bleeding sources were identified by DBE in 41 of 57 in the overt cases and 9 of 9 in the occult cases. Small intestinal ulcer was the commonest cause of bleeding and observed in 18 and 4 patients in the overt and occult cases, respectively. Tumors and angiodysplasia are other major source of bleeding. Among 41 cases with overt bleeding, endoscopic hemostasis was done in 13 patients (7 angiodysplasias; 2 ulcers) without complications, and surgical operation was chosen in 10 patients (4 tumors; 2 Meckel diverticula; 2 blind loop ulcerations). Control of bleeding was completely or partially achieved in 33 and 2 patients, respectively. Among 9 cases with occult bleeding, endoscopic hemostasis was done in 1 patient without complications, and surgical operation was chosen in 5 patients (2 tumors; 2 ulcers). Control of bleeding was completely or partially achieved in 5 and 1 patients of the occult cases, respectively. Overall outcomes of these 66 patients were ÒresolvedÓ in 44 patients and ÒimprovedÓ in 3 patients. Specifically bleeding was stopped and did not recur during the follow-up period in 13 of 14 patients who experienced endoscopic hemostasis with DBE. Conclusions: DBE is effective for the identification of bleeding source in patients with obscure bleeding including both overt and occult cases. DBE can perform endoscopic intervention such as hemostasis safely and effectively, and can also improve clinical outcome of these patients. Background and Aims: GI bleeding is a common disorder and source of bleeding cannot be identified with conventional EGD and colonoscopy in about 5% of the patients. We developed double-balloon endoscopy (DBE), a novel technique capable of accessing entire small intestine and evaluated diagnostic/therapeutic availability and clinical outcomes of DBE for obscure gastrointestinal bleeding. Methods: For 123 patients, 178 DBE examinations were performed between Sep. 2000 and Mar. 2004 at Jichi medical school hospital, Tochigi, Japan, and sixty-six consecutive patients who had obscure gastrointestinal bleeding were followed up. Conventional EGD and colonoscopy prior to DBE showed no potential source of bleeding in these patients. 57 patients had overt gastrointestinal bleeding and 9 patients had occult gastrointestinal bleeding, and diagnostic yield, therapeutic effectiveness, and outcomes of these two groups were analyzed. Patients were followed-up for 164 days on the average after the first DBE examination. Results: Bleeding sources were identified by DBE in 41 of 57 in the overt cases and 9 of 9 in the occult cases. Small intestinal ulcer was the commonest cause of bleeding and observed in 18 and 4 patients in the overt and occult cases, respectively. Tumors and angiodysplasia are other major source of bleeding. Among 41 cases with overt bleeding, endoscopic hemostasis was done in 13 patients (7 angiodysplasias; 2 ulcers) without complications, and surgical operation was chosen in 10 patients (4 tumors; 2 Meckel diverticula; 2 blind loop ulcerations). Control of bleeding was completely or partially achieved in 33 and 2 patients, respectively. Among 9 cases with occult bleeding, endoscopic hemostasis was done in 1 patient without complications, and surgical operation was chosen in 5 patients (2 tumors; 2 ulcers). Control of bleeding was completely or partially achieved in 5 and 1 patients of the occult cases, respectively. Overall outcomes of these 66 patients were ÒresolvedÓ in 44 patients and ÒimprovedÓ in 3 patients. Specifically bleeding was stopped and did not recur during the follow-up period in 13 of 14 patients who experienced endoscopic hemostasis with DBE. Conclusions: DBE is effective for the identification of bleeding source in patients with obscure bleeding including both overt and occult cases. DBE can perform endoscopic intervention such as hemostasis safely and effectively, and can also improve clinical outcome of these patients.