Effectiveness of Video Capsule Endoscopy (VCE) and Double Balloon Enteroscopy (DBE) in Diagnosis and Treatment of Small Bowel Pathology

Abstract

Introduction: The combination of VCE and DBE has improved the ability to diagnosis and treat pathology in the small bowel. However there are few outcomes data. Methods: We performed a retrospective chart review of all patients referred to a tertiary university medical center for suspected small bowel disease, who underwent both VCE and DBE between July 2005 and October 2007. 51 patients underwent 56 VCE and 59 DBE procedures. The primary goal of this study was to evaluate the effectiveness of the VCE and DBE in diagnosing and treating small bowel lesions in a retrospective survey at one center. Procedure time, adverse events, endoscopic interventions and outcome after DBE were secondary aims. Results: Demographics of the 51 patients are described in Table 1. VCE was performed with the PillCamSB Given Imaging. Of the 59 DBE, 44 were antegrade and 15 were retrograde . Mean duration of DBE was 82 minutes. 2 patients are excluded as the DBE could not be advanced beyond the sigmoid colon. Results of 49 patients who underwent successful VCE and DBE procedures are described in table 2. Small bowel abnormalities were detected using VCE in 46 (94%) and DBE in 28 (57%) (p < 0.0001) of the 49 patients. Complications were limited to a perforation with DBE after snare polypectomy, that was managed laparoscopically. Interventions were performed in 23 (46%) patients with DBE. 4 patients had small bowel resections. Follow-up of 37 patients for 2-27 months revealed that 26 required no further intervention, 3 required further transfusions, 5 underwent surgery, one scheduled for surgery and 2 died due to non- procedure related causes. Conclusions: When VCE findings are confirmed by DBE there is a high likelihood of intervention. DBE was associated with a decrease in patients requiring transfusions and (26/49) 53% of the patients required no further interventions. Complications were infrequent and limited to therapeutic procedures and sedation. Table 1 Total number of patients Age in years mean; (range) Sex- Male: Female Body mass Index mean;(CI) 51 59.6;(19-89) 32:19 29.9 (27.9-31.9) Number of patient on NSAIDS (%) Number of patient on oral anticoagulants (%) 9(18%) 8(16%) Number of patients with previous history of CVD disorder (yes/no) Number of patients with previous history of renal disease (yes/no) Number of patients with prior abdominal surgery (yes/no) 11/40 4/46 23/28 Duration of symptoms in months, mean; range Number of patients requiring blood transfusions (yes /no) Number of units transfused (range) Blood hemoglobin level mean; (CI) 25.6; 1-84 26/8 0-137 9.9; (9-10.8) Obscure Overt Bleeding;n Obscure Occult Bleeding;n PJS;n Diarrhea;n Suspected Crohns Disease;n Abdomen pain;n Lymphoma surveillance;n 21 20 3 3 2 1 1 n = number of patients CI = confidence interval Open table in a new tab Table 2VCE & DBE in 49 patients Detection of lesions VCE & DBE (+) N = 27 VCE & DBE (-) N = 2 VCE (-) DBE (+) N = 1 VCE (+) DBE (-) N = 19 Lesions AVM-12 Active bleeding-5 Polyps- 8 VCE shows Active bleeding and DBE shows AVM = 1 VCE shows Polyp and DBE shows diverticulum-1 AVM = 1 AVM -4 Active Bleeding-6 Polyps-3 Ulcer/inflamation-6 Intervention APC -14 Polypectomy-4 Tattoo 1 Biopsy 2 Small bowel Resection = 4 (Carcinoid-1 GIST -1 Hemorrhage-1 Fragile ileal mucosa syndrome -1) APC = 1 Biopsy-2 Tatoo -8 Follow-Up of 37 patients No intervention-16 RequiringTransfusion-1 Surgery pending(Carcinoid) -1 Surgery -4(GIST-2,Hemorrhage-2) No intervention -1 Death-1 No intervent-ion-1 Death-1 RequiringTransfusion-2 No intervention-8 Surgery-(carcinoid)1 VCE- video capsule endoscopy, DBE- double balloon enteroscopy,AVM-arterio venous malformation,APC-argon plasma coagulation,GIST- Gastrointestinal stromal tumor,N = number of patients. Open table in a new tab n = number of patients CI = confidence interval VCE- video capsule endoscopy, DBE- double balloon enteroscopy,AVM-arterio venous malformation,APC-argon plasma coagulation,GIST- Gastrointestinal stromal tumor,N = number of patients.