Factors Affecting Route Selection of Balloon-Assisted Enteroscopy in Patients with Obscure Gastrointestinal Bleeding: A KASID Multicenter Study.

Dong Hoon Baek,Dong-Hoon Yang,Eun Ran Kim,Seonyeong Hwang,Jinsu Kim,Chang Soo Eun,Seong Ran Jeon,Jong Pil Im,Soo Jung Park,Hyun Joo Jang,Sung Hoon Jung

doi:10.3390/diagnostics11101860

Abstract

Balloon-assisted enteroscopy (BAE) is an important diagnostic modality for ongoing obscure gastrointestinal bleeding (OGIB). However, it is difficult to determine the optimal insertion route. We retrospectively analyzed the records of patients with OGIB contained in a multicenter enteroscopy database of 1108 balloon-assisted enteroscopy (BAE) procedures (875 patients) to find out factors affecting BAE route selection in patients with OGIB. A total of 603 BAE procedures in 512 patients were investigated: there were 392 (65.0%) bidirectional and 211 (35.0%) unidirectional procedures. Overt OGIB was more frequent in the latter group (p = 0.024). Computed tomography (CT) was more frequently performed in the unidirectional group (p < 0.001). Capsule endoscopy and a small bowel barium study were performed more frequently in the bidirectional group (p < 0.001 and p = 0.039, respectively). Multivariate analysis showed that occult OGIB, capsule endoscopy and a small bowel barium study were independently associated with use of the bidirectional approach (p = 0.011, p = 0.013 and p = 0.046, respectively). Conversely, CT was associated with use of the unidirectional approach (p < 0.001). Conclusion: CT can aid the selection of an optimal insertion route in OGIB patients. However, capsule endoscopy and small bowel barium study are unhelpful.

Highlights

Obscure gastrointestinal bleeding (OGIB), until recently termed small bowel bleeding or potential small bowel bleeding, is relatively rare, accounting for 5–10% of all cases of gastrointestinal (GI) bleeding [1,2,3]
We reviewed a total of 1108 Balloon-assisted enteroscopy (BAE) performed on 875 patients
603 BAEs of 512 patients with OGIB were included in the final analysis (Figure 1)

Summary

Introduction

Obscure gastrointestinal bleeding (OGIB), until recently termed small bowel bleeding or potential small bowel bleeding, is relatively rare, accounting for 5–10% of all cases of gastrointestinal (GI) bleeding [1,2,3]. Various imaging modalities, including video capsule endoscopy (VCE), deep enteroscopy and radiographic imaging have been applied to the small bowel. The utility of these modalities depends on the extent of bleeding and the patient’s condition. The Japanese guidelines propose that computed tomography (CT) should be considered before capsule endoscopy as the first-line procedure for small bowel evaluation. Device-assisted enteroscopy (DAE) is recommended for patients with persistent overt bleeding or who are OGIB-positive on capsule endoscopy or CT. A recent study introduced a new form of enteroscopy; prototype single-balloon enteroscopy with passive bending and high force transmission that helps deep insertion into the small intestine [10], but the use of DAEs still has technical limitations. We aimed to identify factors affecting DAE route selection in OGIB patients by analyzing a large, multicenter enteroscopy database

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