Diagnostic Yield Of Double-balloon Enteroscopy Research Articles

Double-balloon enteroscopy and outcomes in patients older than 80.

double-balloon enteroscopy (DBE) is becoming more commonly used for investigation of small bowel pathology. Currently, there are limited data to describe its safety and efficacy in the population over age 65. to investigate the indications, findings and outcomes of DBE performed in patients older than 80, as well as the correlation between DBE and prior capsule endoscopy (CE) findings. we retrospectively reviewed our large DBE database, including procedures from January 2006 to September 2012. Patients aged 80 or older at the time of DBE were included in the study. The indications, findings, outcomes and diagnostic yield of DBE were calculated by frequency analysis. two hundred and fifteen DBEs were performed in 130 patients aged 80 or older. The mean age was 83.6 ± 3.03 years (range: 80-94). Twelve patients (9.2%) were assigned an American Society of Anaesthesiologists score of II prior to procedure, 102 patients (78.4%) were assigned a score of III and 16 patients (12.3%) were given a score of IV. The most common indication for DBE was obscure gastrointestinal bleeding (N = 204, 94.9%). One hundred and fourteen patients (87.7%) underwent CE prior to DBE, and correlation between findings of CE and DBE occurred in 74.6% of these patients. The overall diagnostic yield of DBE was 77.2% (N = 166). There were no immediate post-procedural complications or failed procedures. DBE is a safe and effective technique for investigation of the small bowel in patients aged 80 and older. Age alone should not be a contraindication to performing DBE when clinically indicated.

The optimal time of double balloon enteroscopy for patients with obscure gastrointestinal bleeding： a case-control study

Objective To investigate the optimal time for double balloon enteroscopy （DBE） in patients with obscure gastrointestinal bleeding （OGIB）. Methods Data of 78 patients with OGIB who underwent DBE from January 2009 to November 2013 were retrospectively analyzed. They were classified into two groups, emergency DBE and non-emergency DBE. The demographic and clinical features and outcomes of DBE, the time of examination and complications were compared. Results The overall diagnostic yield of DBE was 48 lesions （61.54 % ）. The overall diagnostic yield of emergency DBE group was 77.14%, which was significantly higher than that in non-emergency DBE group （48. 83% ） （P = 0. 019）. The time of examination in emergency group was shorter than that of non-emergency group with significant difference （P = 0. 031 ）. Conclusion Emergency DBE takes less time and yields a higher rate of detection. Patients with OGIB should receive DBE as soon as possible. Key words: Double balloon enteroscopy; Diagnosis; Obscure gastrointestinal bleeding

Double-balloon enteroscopy in Ireland in the capsule endoscopy era

The availability of double-balloon enteroscopy (DBE) and small bowel capsule endoscopy (SBCE) in Ireland has revolutionised our approach to the diagnosis and treatment of small bowel disorders. To evaluate the use of DBE in Ireland and to compare the diagnostic yield with and without prior SBCE in order to improve the efficiency of our resources for small bowel endoscopy. A retrospective comparison study of all DBEs performed between two centres, one with SBCE available, was undertaken. Information was obtained by review of endoscopy reports, referral letters, radiology reports and charts. A review of the SBCE database was undertaken to identify patients who had undergone SBCE prior to DBE. A total of 242 DBE procedures were carried out between both centres. SBCE was performed prior to DBE in 20 % (n = 46). The overall diagnostic yield of DBE was 47 % (n = 115). There was a statistically significant difference in diagnostic yield between the DBE only and the DBE with prior SBCE groups 44 versus 61 %, respectively, p < 0.0001. There was also a significant difference in the DBE approach, with 73 % of procedures being anterograde in centre 1 versus 56 % in centre 2. A subgroup analysis of centre 1 data revealed a negative predictive value of 100 % and a positive predictive value of 74 % for SBCE when DBE findings were considered as a gold standard. SBCE as a screening tool prior to DBE is extremely valuable and increases the diagnostic yield considerably as a consequence of a high negative predictive value.

Diagnostic and Therapeutic Utility of Double‐Balloon Enteroscopy in Children

Diagnostic and therapeutic benefits of double-balloon enteroscopy (DBE) have been documented in adults, with few data available on pediatric patients. We evaluated the diagnostic and therapeutic utility of DBE in children. A prospective assessment of 113 DBE procedures in 58 consecutive children younger than 18 years (36 boys, 22 girls; median age 12.7 years, range 1-18 years) was performed for a variety of suspected small bowel (SB) disorders from January 2008 to August 2012 in a tertiary referral center for pediatric patients. All of the children had undergone upper gastrointestinal endoscopy and ileocolonoscopy. A total of 19 patients had undergone radiological investigations for SB (n = 11 magnetic resonance imaging; n = 5 barium enterography; n = 3 computed tomography) and 54 patients had undergone wireless capsule endoscopy (WCE). The overall median (range) examination time was 92.5 (45-275) minutes. The median (range) estimated insertion length of SB distal to pylorus was 230 (80-450) cm and proximal to ileocecal valve was 80 (5-275) cm. The common indications for DBE were polyposis syndromes (n = 21) and obscure gastrointestinal bleeding (n = 16). The findings included polyps (n = 19), mucosal ulcers and erosions (n = 8), submucosal elevations with white nodules (n = 4), and angioma/angiodysplasia (n = 2). The overall diagnostic yield for SB lesions using DBE was 70.7% (41/58) and for WCE was 77.7% (42/54). Endotherapeutic intervention was successfully used in 46.5% (n = 27/58). The endoscopic, medical, and surgical contributions to change in management by DBE were 72.4% (n = 42/58). Three complications (5.2%) were noted with uneventful recovery. The diagnostic yield of DBE was comparable to WCE, but with the addition of therapeutic possibility and histological yield. We believe this technique could be a valuable addition to existing endoscopic techniques, complementary to WCE, and may be considered as an alternative diagnostic and therapeutic option in the SB in children.

Double-balloon enteroscopy in elderly patients: is it safe and useful?

Background/AimsProviders may be hesitant to perform double-balloon enteroscopy (DBE) in the elderly because the increased number of co-morbidities in this population poses a greater risk of complications resulting from sedation. There are limited data on the use of DBE in the elderly. Here, we assessed the safety and efficacy of DBE in the elderly compared to those in younger patients.MethodsWe retrospectively analyzed the medical records of 158 patients who underwent 218 DBEs. Patients were divided into an elderly group (age ≥65 years; mean 71.4±5.4; n=34; 41 DBEs) and a younger group (age <65 years; mean 39.5±13.5; n=124; 177 DBEs).ResultsIn both groups, the most common indication for DBE was obscure gastrointestinal bleeding. Mucosal lesions (33.3% vs. 60.9%; P=0.002) were the most common finding in both groups, followed by tumors (30.8% vs. 14.1%; P=0.036). The elderly were more likely to receive interventional therapy (51.3% vs. 23.5%; P=0.001). The diagnostic yield of DBE was slightly higher in the elderly group (92.3% vs. 86.5%; P=0.422), but was not statistically significant. The therapeutic success rate of DBE was 100% in the elderly group compared to 87.5% in the younger group (P=0.536). The overall DBE complication rate was 1.8% overall, and this rate did not differ significantly between the groups (2.6% vs. 1.7%; P=0.548).ConclusionsDBE is safe and effective in the elderly, and has a high diagnostic yield and high therapeutic success rate.

Double Balloon Enteroscopy Procedure in Patients with Surgically Altered Bowel Anatomy: Analysis of a Large Prospectively Collected Database

Patients with surgically altered bowel anatomy frequently undergo the double balloon enteroscopy (DBE) procedure to evaluate various small bowel diseases. There are limited data on the diagnostic yield and safety of DBE in these patients. We evaluated the diagnostic yield and complication rates of DBE in patients with surgical altered bowel anatomy. We also evaluated the success rate of DBE in achieving complete examination of the excluded segment of the small bowel and excluded stomach in these patients. Our study was a single-center retrospective analysis of a large prospectively collected DBE database. Patients with a history of surgically altered bowel anatomy who had a DBE procedure performed between January 2006 and August 2011 were included in the study analysis. Patients' demographics, procedure indications, findings, endoscopic interventions, and postprocedural recovery data were recorded. We used frequency statistics to calculate the diagnostic yield and complication rates of DBE in these patients. In total, 1215 DBEs were performed at our institution during the study period. Sixty-two patients with a history of altered bowel anatomy underwent 53 DBEs and 11 DBE-assisted endoscopic retrograde cholangiopancreatographies (ERCPs). The overall diagnostic yield of DBE was 61%, and that of DBE-assisted ERCP was 64%. No serious early or delayed DBE-associated complications were identified. In patients with surgically altered bowel anatomy containing excluded small bowel and excluded stomach, DBE success rate to achieve their complete examination was 92% (n=46). DBE including DBE-assisted ERCP is feasible, safe, and associated with reasonably high diagnostic yield in patients with surgically altered bowel anatomy.

Double-balloon enteroscopy for diagnosis of Meckel's diverticulum: Comparison with operative findings and capsule endoscopy

Meckel's diverticulum (MD) is one of the most common congenital gastrointestinal malformations. It is difficult to make a preoperative diagnosis of MD. To date, few data are available describing the diagnosis of MD by double-balloon enteroscopy (DBE) and capsule endoscopy (CE). To assess the value of DBE in the diagnosis of MD and comparatively evaluate the diagnostic yield of DBE and CE for MD. A single-center study was performed on patients with a confirmed diagnosis of MD by surgery and postoperative pathology between January 2003 and December 2011. Seventy-four patients (60 males) with a mean age of 29.0 ± 14.3 years were analyzed; 33 (55.0%) were between 21 and 40 years of age. Gastrointestinal bleeding was the major finding in 86.5% of the patients who were referred for DBE or CE examination. The mean duration of symptoms was 32.3 ± 48.7 months. In the 74 patients, the diagnostic yield of DBE for MD before surgery was 86.5% (64/74), and correct diagnoses were made in the majority of cases by retrograde DBE, with a few cases by antegrade DBE. In the 26 patients undergoing CE before DBE, the overall diagnostic yield of DBE was 84.6%, significantly greater than that of CE (7.7%, P < .000, McNemar's χ(2) test). Poor agreement was found between the 2 modalities (kappa = 0.03). For patients who are highly suspected of having MD, DBE provides a safe, effective, and reliable means of diagnosis before surgery.

Changes Over Time in Indications, Diagnostic Yield, and Clinical Effects of Double-Balloon Enteroscopy

We performed a retrospective study to investigate changes between different time periods in the indications, diagnostic yield, and clinical impact of double-balloon enteroscopy (DBE). We analyzed records from the database at Soonchunhyang University College of Medicine from all patients undergoing DBE between September 2004 and May 2011 (181 DBEs, 133 patients). We compared DBE-related factors between the first stage (September 2004-August 2006; 117 DBEs, 79 patients) and second stage (September 2006-May 2011; 64 DBEs, 54 patients) of the study period. The number of DBEs performed decreased between stages. Obscure gastrointestinal bleeding was the most common indication for DBE during each stage (65.8% vs 50%; P = .06). Abnormalities in other modalities as the second indication increased significantly in the second stage compared with the first (11.4% vs 29.6%; P = .008). Between stages, use of computed tomography increased (53.8% vs 81.5%; P = .001), along with capsule endoscopy (29.1% vs 44.4%; P = .06). Mucosal lesions were the most common finding in each stage (56% and 53.1%; P = .686). The diagnostic yield of DBE was 89.3% in the first stage and 93.9% in the second (P = .384). In the first stage, DBE identified 86.4% of cases that had negative results from other modalities; in the second, it identified all cases (P = .3). Therapeutic plans were determined in 89.7% of patients only on the basis of results from DBE. Between the time periods of 2004-2006 and 2006-2011, the clinical indications for DBEs and outcomes did not change. However, the selectivity of the number of patients decreased between stages.

Mo1964 Efficacy and Safety of Endoscopic Studies in 207 Pediatric and Young Adult Patients: A Japanese Single Children's Hospital Experience

Background: The life expectancy of the population is rising. The number of octogenarian (80 years or older) undergoing endoscopy evaluation is rising. The utility of double balloon enteroscopy (DBE) procedure in Octogenarians have not been previously reported. Aim: To determine the safety and diagnostic yield of DBE procedure in the octogenarians. Methods: We reviewed our large prospectively collected DBE database from 2006 to 2011. The octogenarian patients aged 80 years or older were included in our study analysis. Patients' demographics along with DBE procedure indication, findings, and complications were recorded. The safety and diagnostic yield of DBE procedure was calculated by the frequency statistics. Results: A total of 1218 DBE procedure were performed from 2006 to 2011 at our tertiary referral center. Out of these DBE procedures, 108 DBE (60 antegrade and 48 retrograde approaches) performed in 86 different patient encounters among 68 octogenarian (54.4% Male) were included in our study analysis. The average age of these patients was 84 (80-95) years and BMI was 26.2 (18.6-45.13) kg/m2. The most common indication for DBE was overt bleeding 29.6% (See table below). The most common finding during these DBE was bleeding AVM (arterio-venous malformation) among 38% (n=33) encounters. The overall diagnostic (pertinent positive findings) or therapeutic yield of DBE was found to be 91.86% (79/86 encounters). The diagnostic and therapeutic yield was found to be 91% (71/ 78 encounters) for evaluation of gastrointestinal bleeding and 100% (5/5 encounters) for evaluation of suspected mass or bowel stricture among octogenarian. There was no immediate (<48 hours) complications occurred in any of these patients. In 55.8% (n=48) of the total 86 encounters, the patients received capsule endoscopy procedure. Among them, capsule endoscopy found specific lesions in 58.3% (n=28) encounters, nonspecific findings in 35.4% (n=17) encounters and negative in only 6.3% (n=3) encounters. Conclusion: The diagnostic (pertinent positive findings) and therapeutic yield of DBE procedure was found to be more than 90% in the octogenarian patients. The DBE procedure in octogenarians was found to be safe without any complications. Indications and findings of DBE in Octogenarians (total n = 86 encounters)

Mo1963 Double Balloon Enteroscopy (DBE) in Octogenarians: Analysis of a Large Prospectively Collected Database

Background: The life expectancy of the population is rising. The number of octogenarian (80 years or older) undergoing endoscopy evaluation is rising. The utility of double balloon enteroscopy (DBE) procedure in Octogenarians have not been previously reported. Aim: To determine the safety and diagnostic yield of DBE procedure in the octogenarians. Methods: We reviewed our large prospectively collected DBE database from 2006 to 2011. The octogenarian patients aged 80 years or older were included in our study analysis. Patients' demographics along with DBE procedure indication, findings, and complications were recorded. The safety and diagnostic yield of DBE procedure was calculated by the frequency statistics. Results: A total of 1218 DBE procedure were performed from 2006 to 2011 at our tertiary referral center. Out of these DBE procedures, 108 DBE (60 antegrade and 48 retrograde approaches) performed in 86 different patient encounters among 68 octogenarian (54.4% Male) were included in our study analysis. The average age of these patients was 84 (80-95) years and BMI was 26.2 (18.6-45.13) kg/m2. The most common indication for DBE was overt bleeding 29.6% (See table below). The most common finding during these DBE was bleeding AVM (arterio-venous malformation) among 38% (n=33) encounters. The overall diagnostic (pertinent positive findings) or therapeutic yield of DBE was found to be 91.86% (79/86 encounters). The diagnostic and therapeutic yield was found to be 91% (71/ 78 encounters) for evaluation of gastrointestinal bleeding and 100% (5/5 encounters) for evaluation of suspected mass or bowel stricture among octogenarian. There was no immediate (<48 hours) complications occurred in any of these patients. In 55.8% (n=48) of the total 86 encounters, the patients received capsule endoscopy procedure. Among them, capsule endoscopy found specific lesions in 58.3% (n=28) encounters, nonspecific findings in 35.4% (n=17) encounters and negative in only 6.3% (n=3) encounters. Conclusion: The diagnostic (pertinent positive findings) and therapeutic yield of DBE procedure was found to be more than 90% in the octogenarian patients. The DBE procedure in octogenarians was found to be safe without any complications. Indications and findings of DBE in Octogenarians (total n = 86 encounters)

Double balloon enteroscopy in the old: experience from China.

To evaluate the safety, efficacy and management of double balloon enteroscopy (DBE) carried out in those aged individuals with suspicious small intestine diseases. DBE is a wonderful invention of the past decade and is widely used as an examination tool for the gastrointestinal tract. From January 2003 to July 2011, data from patients who were ≥ 65 years old and underwent DBE examination in the Nanfang Hospital were included in a retrospective analysis. Fifty-nine individuals were found and subsequently analyzed. The mean age was 69.63 ± 3.89 years (range 65-84), 34 were males. Indications for DBE were melena/hematochezia (36 cases), abdominal pain (15 cases), diarrhea (3 cases), stool change (1 case), weight loss (1 case), vomiting (2 cases), and debilitation (1 case). The average duration of symptoms was 33.34 ± 64.24 mo. Twenty-seven patients suffered from age-related diseases. Severe complications were not found during and after DBE. Comparison between systolic and diastolic blood pressure before and after DBE was statistically significant (mean ± SD, P < 0.01, P < 0.05, respectively). Small bowel pathologies were found by DBE in 35 patients, definite diagnoses were made in 31 cases, and detection rate and diagnostic yield for DBE were 68.6% and 60.8%, respectively. DBE is a safe and effective method for gastrointestinal examination in the aged population. Aging alone is not a risk factor for elderly patients with suspicious gastrointestinal diseases and thorough preparation prior to the DBE procedure should be made for individuals with multiple diseases especially cardiopulmonary disorders.

Capsule endoscopy and double balloon enteroscopy for obscure gastrointestinal bleeding: Which is better?

See article in J. Gastroenterol. Hepatol. 2011; 26: 796–801.

Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: An updated meta‐analysis

Uncertainty remains about the best test to evaluate patients with obscure gastrointestinal bleeding (OGIB). Previous meta-analyses demonstrated similar diagnostic yields with capsule endoscopy (CE) and double balloon enteroscopy (DBE) but relied primarily on data from abstracts and were not limited to bleeding patients. Many studies have since been published. Therefore, we performed a new meta-analysis comparing CE and DBE focused specifically on OGIB. A comprehensive literature search was performed of comparative studies using both CE and DBE in patients with OGIB. Data were extracted and analyzed to determine the weighted pooled diagnostic yields of each method and the odds ratio for the successful localization of a bleeding source. Ten eligible studies were identified. The pooled diagnostic yield for CE was 62% (95% confidence interval [CI] 47.3-76.1) and for DBE was 56% (95% CI 48.9-62.1), with an odds ratio for CE compared with DBE of 1.39 (95% CI 0.88-2.20; P = 0.16). Subgroup analysis demonstrated the yield for DBE performed after a previously positive CE was 75.0% (95% CI 60.1-90.0), with the odds ratio for successful diagnosis with DBE after a positive CE compared with DBE in all patients of 1.79 (95% CI 1.09-2.96; P = 0.02). In contrast, the yield for DBE after a previously negative CE was only 27.5% (95% CI 16.7-37.8). Capsule endoscopy and double balloon enteroscopy provide similar diagnostic yields in patients with OGIB. However, the diagnostic yield of DBE is significantly higher when performed in patients with a positive CE.

Double balloon enteroscopy in the era of capsule endoscopy: necessity or luxury?

IntroductionThe use of double balloon enteroscopy (DBE) in the UK has been relatively slow and limited to tertiary centres. The authors evaluated the demand for DBE in the UK and...

Diagnostic value of double balloon enteroscopy for intestinal diseases

Objective To assess the diagnostic value of double balloon enteroscopy （DBE） for sus- pected intestinal diseases. Methods The data of 141 patients with suspected intestinal diseases, who un- derwent DBE with intravenous sedation from July 2007 to November 2009, were retrospectively analyzed. Oral and anal routes DBE were performed in 59 and 46 patients, respectively, while 36 patients underwent a com- bination of both approaches. Results The overall diagnostic yield of DBE was 74. 5% （ 105/141 ）, with benign and malignant tumors in 32, Crohn＇s disease in 14, non-specific enteric inflammation in 17, polyp in 15, divertieulosis in 16, vascular lesions in 9, intestinal tuberculosis in 3 and intestinal aneylostomiasis in 1. Acute panereatitis was complicated in 1 patient. Conclusion DBE is a safe and effective method in diagnosis of suspected intestinal diseases. Key words: Diagnosis; Double Balloon enteroscopy; Small intestinal disease

OC-025 The first report of the UK multicentre double balloon enteroscopy registry: broadening the international deep enteroscopy experience: Abstract OC-025

Introduction Double balloon enteroscopy (DBE) has been a pivotal endoscopic technology, transforming the investigation and management of small bowel (SB) disorders by facilitating direct endoscopic access of the entire small bowel. Methods We report the initial experience of the UK multicentre registry (six centres) since the introduction of DBE in the UK in 2005. Results 550 cases (322 men) were performed. Mean age was 56 years (16–94 years). 189 cases were done under general anaesthesia, 361 cases done under conscious sedation. 372 cases were performed via the oral route, 175 were performed via the rectal route while three cases were performed via an ileostomy. Calculated mean depth of insertion was 270±80 cm and 190±75 cm for oral and rectal routes, respectively. Mean time taken to complete procedures was 74±20 min. Carbon dioxide was used as the insufflating gas in 344 cases while air was used in the remaining 206 cases. DBE was preceded by capsule endoscopy (CE) in 403 cases. Concordance of diagnoses at CE and DBE was 66% and the overall diagnostic yield for DBE was 61%. The indications and therapies applied at DBE are shown (Abstract 025). Significant lesions missed by CE but diagnosed by DBE included large vascular lesions, polyps and other small bowel tumours. Endoscopic therapy at DBE was applied in 38% of procedures. There were three reported complications (2 perforations and 1 acute coronary syndrome); all complications occurred during therapeutic procedures. The overall complication rate for DBE in the series was 0.5%, with a complication rate for therapeutic procedures of 1.4%. There were no cases of acute pancreatitis. Limitations to DBE procedures included patient intolerance, the presence of adhesions and poor bowel preparation. Conclusion The initial UK experience is favourable and echoes the results of other national series published to date, showing that DBE is a feasible and safe and endoscopic advancement that enhances the management of small bowel disorders.

Use of double-balloon enteroscopy in the management of patients with Crohn’s disease: feasibility and diagnostic yield in a high-volume centre for inflammatory bowel disease

Double-balloon enteroscopy (DBE) is theoretically useful in Crohn's disease (CD) since it is potentially able to investigate the whole small intestine, but sparse data are available. To assess the feasibility, safety, and diagnostic yield of DBE in CD. The study was conducted in a tertiary care centre for inflammatory bowel disease. Thirty-seven patients with CD (18/19 male/female, mean age 42 years, range 13-77 years) were considered. Thirty-two DBEs from the oral approach and 18 from the anal (in 6 patients from both ways with a complete exploration in 4, 10.8%) were performed. Indications were: first diagnosis/staging in 16 cases, diagnosis of stenosis in 7, obscure bleeding in 10, suspected neoplasia in 2, and postsurgical evaluation in 2. One hundred and thirty-three other procedures (3.7 per patient) were performed with the same indication. Insertion depth from the oral route was 266.5 ± 100 cm and from the anal route 72.5 ± 60 cm. Ileocecal valve was passed in 8/13 patients, but in 4 DBE explored less than 50 cm of ileum. Diagnostic yield was 59.4% but changed according to indication (40% in obscure bleeding, 100% in case of strictures) and was higher when DBE was conducted on the basis of previous investigations (77.8% versus 40%, p = 0.037). DBE is a feasible, useful, but technically demanding method in CD. Definition of the proper introduction route by means of previous investigations is associated with a higher efficacy of DBE.

Small Bowel Evaluation By Double-Balloon Enteroscopy in Pediatric Patients: Results of Two University Hospital Endoscopy Units

Introduction: Double-balloon enteroscopy (DBE) enables complete endoscopic intubation of the gastrointestinal (GI) tract. Both Fujinon EN-450P5 pediatric and EN-450T5 treatment endoscopes are available, differing in outer diameter and diameter of the accessory channel. Aim: We evaluated feasibility and diagnostic yield of DBE in a pediatric population with suspected small bowel pathology. Methods: Retrospectively, all DBE procedures in pediatric patients (age <18 years) were evaluated, using the DBE database of both university hospitals.

A Comparison of Diagnostic Yield and Degree of Agreement Between Capsule Endoscopy and Double Balloon Enteroscopy in Evaluating Small Intestinal Disorders

Purpose: The aim of our study is to compare the diagnostic yield and degree of agreement between Capsule Endoscopy (CE) and Double Balloon Enteroscopy (DBE) in evaluating small bowel disorders. Methods: Following IRB approval, we undertook a retrospective chart review of 119 consecutive patients who underwent both CE and DBE from January 2005 to August 2006. The indications for DBE were obscure overt GI bleeding (42%), obscure occult GI bleeding (37%), suspected mass (10%), mucosal changes (10%) and retained capsule (1%). The degree of agreement between CE and DBE was assessed using Cohen's kappa statistics. Results: 55 (46%) males and 64 (54%) females underwent both DBE and CE. The mean age was 62 ± 19.8 years (range 17–100 years). CE was abnormal in 74 (62%) patients compared to DBE which revealed abnormalities in 80 (67%) patients. For agreement between the two tests, there was a trend towards significance (kappa value = 0.28, P= .06). Among 45 patients with negative CE, DBE revealed small bowel pathology in 24 (53.3%) patients whereas in 37 patients with negative DBE, CE suspected a small bowel pathology in 18 (48%) patients. DBE revealed small intestinal diverticuli in 7 patients (5.9%) whereas CE failed to show them. Discussion: Our study confirms that CE and DBE supplement each other in studying small bowel disorders, in particular obscure GI bleeding. Although CE and DBE have comparable overall diagnostic yield, DBE detects more small bowel diverticuli and normal variants. While CE appears to have higher diagnostic yield in detecting ulcers, masses and active bleeding, it may be falsely positive in some of these patients where DBE clarifies the diagnosis by accurately identifying the normal variants. DBE also demonstrates the underlying pathology in patients with active bleeding on CE. Conclusion: The overall diagnostic yield of DBE is comparable with CE in detecting small bowel pathology. There is a trend towards significance for agreement between CE and DBE and a higher sample size will likely achieve the statistical significance.Table

Clinical Utility of Double-Balloon Enteroscopy for Small Intestinal Bleeding

Until the development of wireless capsule endoscopy (CE) and double-balloon enteroscopy (DBE), it was extremely difficult to examine the entire small intestine. To assess the usefulness of DBE for diagnosing suspected small intestinal bleeding, we retrospectively compared the diagnoses and treatments of cases before and after its introduction at one hospital. Between September 2003 and December 2005, 21 consecutive patients with suspected small intestinal bleeding underwent DBE at Tokai University Hospital (group A), and subsequently 2 were excluded from the study after being diagnosed with bleeding from a diverticulum and an angiodysplasia in the ascending colon, respectively. For comparison, inpatients who were negative for gastrointestinal bleeding on colonoscopy and gastroscopy between May 1998 and August 2003 were reviewed and 27 consecutive patients who had not undergone DBE were selected as the control group (group B). All patients had been diagnosed negative for a source of bleeding on more than one colonoscopy and gastroscopy. There were no significant differences between the two groups in terms of age, gender, history of blood transfusion, blood hemoglobin value on admission, or symptoms. The diagnostic yield of DBE in identifying the source of bleeding was 78.9%: six cases of small intestinal ulcers, five cases of angiodysplasia, two cases of hard submucosal tumor (SMT), one case of small pulsating SMT, and one case of small intestinal cancer. DBE was also used to successfully treat three cases of angiodysplasia with argon plasma coagulation. In the control group, conventional investigations, including enteroclysis, angiography, Meckel scan, scintigraphy with technetium-labeled red blood cells, and/or push enteroscopy, were performed in 88.9%, 29.6%, 29.6%, 55.6%, and 25.9%, respectively. The overall diagnostic yield of the conventional approaches was only 11.1% (P < 0.01), comprising a Meckel's diverticulum, a polyp, and an angiodysplasia. We conclude that DBE can be used to diagnose suspected small intestinal bleeding and to treat some cases, such as angiodysplasia.