Double Balloon Enteroscopy (DBE) in the Elderly: Indications, Findings, and Agreement with Video Capsule Endoscopy

Abstract

Introduction: DBE is useful in the diagnostic evaluation and treatment of obscure GI bleeding and small bowel pathology. Limited data are available on indications, findings and agreement between DBE and video capsule endoscopy (CE) in older patients. Aim: To evaluate the distribution of indications, findings and overall agreement of DBE with CE in patients according to age (< or > 75 years). Methods: Retrospective review of DBE procedures at our center between August 2007 and August 2008 in patients divided by age (< and > 75 years). Results: A total of 216 DBE procedures in 170 patients (87 male, 144 White) were reviewed. The mean age of patients studied was 66 +/- 16.4 yrs. (range 20-95 yrs.). Within this group, 60 patients (79 procedures) were > age 75. The most common indications for DBE in patients > age 75 were obscure GI bleeding (96%) and abnormal CE (70.9%). The most common indications for DBE in patients < age 75 were obscure GI bleeding (79.6%), abnormal CE (66.4%), and abnormal SBFT/CT/MRI (14.6%). A higher percentage of patients > age 75 were on anti-platelet medications (42% vs. 33.6%) and anti-coagulation therapy (26.7% vs. 11.8%) compared to patients < age 75. The most common DBE findings in patients > age 75 were angioectasia (39%), erosion/ulcer (10.1%), and polyp/mass (9%). The most common DBE findings in patients < age 75 were angioectasia (23%), polyp/mass (14%), and erosion/ulcer (11.5%). In patients > age 75 there was agreement between DBE findings and CE findings in 19/43 patients (44.1%). In patients < age 75 there was agreement between DBE findings and CE findings in 23/72 patients (31.9%). Endoscopic therapy was indicated in 38/79 (48.1%) procedures for patients > age 75 and 45/137 (32.8%) procedures for patients < age 75. Endoscopic therapy was successful in 32/38 (84.2%) cases for patients > age 75 and 34/45 (75.6%) for patients < age 75. Conclusions: A greater percentage of patients > age 75 have angioectasias, and are more likely to require endoscopic therapy than younger patients, while patients < age 75 have a higher percentage of polyps/mass lesions found on DBE. The agreement between findings on DBE and prior abnormal CE are relatively low in both age groups. In patients > 75 the greater likelihood of finding angioectasias requiring therapy suggests that an earlier role for DBE in elderly patients may be appropriate.