The Usefulness of Double-Balloon Enteroscopy in Patients with Gastrointestinal Bleeding of Obscure Origin

Abstract

Background and Aim: Wireless capsule endoscopy permits examination of the entire small intestine, but it is limited in cases of gastrointestinal bleeding and lacks tissue sampling and therapeutic capabilities. Yamamoto et al. established a new double-balloon insertion method, which allows endoscopic scrutiny and intervention throughout the entire small bowel. The aim of this study was to evaluate the efficacy of double-balloon enteroscopy in patients with gastrointestinal bleeding of obscure origin. Methods: Between August 1, 2003, and July 31, 2004, 31 consecutive patients (18 males, 13 females; mean age 56.4 ± 3.2 years, range 9-80 years) with gastrointestinal bleeding of obscure origin were enrolled in this study, gave informed consent, and underwent double-balloon endoscopy for the following indications: (1) documented iron deficiency anemia (baseline hemoglobin □…10 g/dl or decrease in hemoglobin of ±2 g/dl over 2 or more months); (2) no site/cause of blood loss detected by upper endoscopy; (3) no site/cause of blood loss detected by lower endoscopy with examination of the terminal ileum. When a site/cause of blood loss was detected, biopsy specimens were obtained, and treatment was performed endoscopically as necessary. Results: No patient suffered procedure-related complications. Bleeding points were identified in 23 patients (74.2%). Twenty-one patients (91.3%) treated for an identified cause of blood loss showed no further bleeding during 8.5 ± 0.6 months of follow-up. Conclusions: Double-balloon enteroscopy is safe, easily performed, and permits observation and treatment of small bowel diseases. This method will allow detailed examination of the small bowel for diagnostic and therapeutic purposes without surgical laparotomy. Background and Aim: Wireless capsule endoscopy permits examination of the entire small intestine, but it is limited in cases of gastrointestinal bleeding and lacks tissue sampling and therapeutic capabilities. Yamamoto et al. established a new double-balloon insertion method, which allows endoscopic scrutiny and intervention throughout the entire small bowel. The aim of this study was to evaluate the efficacy of double-balloon enteroscopy in patients with gastrointestinal bleeding of obscure origin. Methods: Between August 1, 2003, and July 31, 2004, 31 consecutive patients (18 males, 13 females; mean age 56.4 ± 3.2 years, range 9-80 years) with gastrointestinal bleeding of obscure origin were enrolled in this study, gave informed consent, and underwent double-balloon endoscopy for the following indications: (1) documented iron deficiency anemia (baseline hemoglobin □…10 g/dl or decrease in hemoglobin of ±2 g/dl over 2 or more months); (2) no site/cause of blood loss detected by upper endoscopy; (3) no site/cause of blood loss detected by lower endoscopy with examination of the terminal ileum. When a site/cause of blood loss was detected, biopsy specimens were obtained, and treatment was performed endoscopically as necessary. Results: No patient suffered procedure-related complications. Bleeding points were identified in 23 patients (74.2%). Twenty-one patients (91.3%) treated for an identified cause of blood loss showed no further bleeding during 8.5 ± 0.6 months of follow-up. Conclusions: Double-balloon enteroscopy is safe, easily performed, and permits observation and treatment of small bowel diseases. This method will allow detailed examination of the small bowel for diagnostic and therapeutic purposes without surgical laparotomy.