ID: 3523942 ENDOCUFF ASSISTED PUSH ENTEROSCOPY INCREASES THE DIAGNOSIS OF GASTROINTESTINAL ANGIODYSPLASIA

Abstract

Gastrointestinal angiodysplasias (GIADs) are the most common cause for suspected small bowel bleeding. Approximately 50% of GIADs do not need treatment secondary to bleeding cessations, while 45% have high re-bleeding rates, causing a significant impact on patient health and VA Healthcare resources. This is likely due to undetected lesions by the current endoscopic methods. Therefore, in this study we evaluated whether endoscopy assisted Endocuff (a device with two rows of soft projections that remain flattened during insertion but spreads out mucosal folds upon withdrawal with push enteroscopy (PE)) could improve GIAD detection. A retrospective chart review of a prospective data collection was performed from January 2006 to December 2018 at VA Loma Linda Healthcare System (VALLHCS) on both inpatients and outpatients with symptomatic GIADs initially detected via video capsule endoscopy (VCE). GIADs observed between 0%-40% small bowel transit time (SBTT) were referred for PE with and without (+/-) the Endocuff device (EC). 25 consecutive patients underwent PE +/- EC. Using PE-EC, GIADs were detected in 9 of 25 (36%) patients. PE+EC detected 23 of 25 (92%) patients with GIADs. The sum of GIADs detected without EC was 26 ± 0.06 vs. 112 ± 0.2 using EC (Figure 1). The average detection rate for PE without EC was significantly lower (1.04 ± 0.06, mean ± SE) when compared to PE with EC (4.48 ± 0.23, mean ± SE, p<0.0005). We found a positive correlation (r=0.25) between CE location of GIADs and SBTT (Figure 2). There were no complications. In conclusion, the EC increases the detection of GIADs and that we reconfirm the location of bleeding GIADs are within the reach of PE. Finally, PE+EC may reduce miss rates of GIADs, which may play a role in the reduction of rebleeding episodes. View Large Image Figure Viewer Download Hi-res image