The Efficacy and Safety of Device-Assisted Enteroscopy and Small Bowel Enteroscopy in Cirrhosis Patients

Abstract

Introduction: Small bowel enteroscopy (SBE) and device-assisted enteroscopy(double balloon enteroscopy, single balloon enteroscopy or SBE-spirus) are commonly used in evaluating and treating obscure gastrointestinal bleeding and lesions in the small bowel. In cirrhotic population, the safety and the success rate of these devices is not well studied in the North America. Our aim in this study is to assess the efficacy and the safety of the device-assisted enteroscopy and SBE and to determine the risk of complications. Methods: A single center, retrospective chart review and analysis of cirrhotic patients between the age of 18 and 80 who had SBE or device-assisted enteroscopy procedure between 2006 and January 2016. We studied the success rate, duration of the procedure, the anesthesia time and complications of the procedures. We also studied the age, sex, MELD score, child-Pugh score (CTP) of the patients. Results: Forty two procedures, 22 SBE and 20 device-assisted enteroscopy, were performed on 33 patients. The average age was 59.3 years (range: 29-86 years). The most common etiologies of cirrhosis were chronic alcohol abuse followed by Non Alcoholic Steatohepatitis (NASH) and chronic hepatitis c virus (HCV). The average MELD score was 16. (Table. 1) The most common abnormal findings were AVM followed by ulcers and inflammatory changes. Longer time needed in the device-assisted enteroscopy than the SBE group as the average time was 58 and 37 minutes respectively (P-value of 0.03). The anesthesia time was longer in the device-assisted enteroscopy with an average of 84 minutes while the average time in the SBE group was 46 minutes (p-value of 0.04). Endoscopic evaluation of the small intestine was successful in 95% of the cohort. The SBE success rate was 100% while the device assisted success rate was 90%. None of the patients had complications or perforation in both groups. (Table 2) Conclusion: Device-assisted enteroscopy and SBE are safe procedures in cirrhotic patients with high success rate. Longer duration and anesthesia time needed for the DAE but no difference was found in the duration of the procedure and the anesthesia time between the decompensated cirrhotic and compensated groups<./p>2888_A Figure 1 No Caption available.2888_B Figure 2 No Caption available.