Spiral Enteroscopy: A Novel Method of Enteroscopy for Evaluation and Treatment of Obscure Gastrointestinal Bleeding Caused by Small Bowel Lesions

Abstract

Obscure gastrointestinal (GI) bleeding most commonly originates in the small bowel. Up to almost 80% of obscure GI bleeding sources are not within the reach of a conventional endoscope or colonoscope hence the need of enteroscopy. Spirus enteroscopy as a new tool for both diagnosis and therapeutic interventions on the small bowel is currently being evaluated for its usefulness on obscure GI bleeding patients. This prospective cohort study included 78 patients who underwent spiral enteroscopy for evaluation of obscure GI bleeding between February 2008 and March 2010 at our institution. Twenty-seven patients with occult-obscure GI bleeding and 51 patients with overt-obscure GI bleeding were studied. Total of 78 patients underwent total of 82 spiral enteroscopies (second spiral enteroscopy was repeated in some patients with negative first spiral enteroscopy) with mean (±SD) maximum depth of insertion of 226 (±80.97). Spiral enteroscopies were able to identify bleeding sources in 48 patients (61.54%). Small bowel lesions accounted for the source of bleeding in 39 patients (81.25%). For total of 82 procedures, the small bowel lesions were arteriovenous malformation (31, 37.8%), diverticulum (6, 7.32%), tumor (2, 2.44%), erosion (1, 1.22%), and ulcer (1, 1.22%). Forty-five patients underwent endoscopic interventions which included biopsies, argon plasma coagulation and bipolar electrocoagulation. There were no procedure related adverse events. In patients with obscure GI bleeding, spiral enteroscopy is safe and effective in diagnosis and has an important role in treatment caused by small bowel lesions.