CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(06): E694-E699
DOI: 10.1055/a-0599-6085
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Outcomes of repeat balloon assisted enteroscopy in small-bowel bleeding

Badr Al-Bawardy
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
,
Guilherme Piovezani Ramos
2  Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
,
Ryan J. Lennon
3  Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
,
Emmanuel Gorospe
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
,
Louis M. Wong Kee Song
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
,
David H. Bruining
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
,
Jeffrey A. Alexander
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
,
Nayantara Coelho-Prabhu
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
,
Jeff L. Fidler
4  Department of Radiology, Mayo Clinic, Rochester, MN, USA
,
Elizabeth Rajan
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
› Author Affiliations
Further Information

Publication History

submitted 06 October 2017

accepted after revision 20 February 2018

Publication Date:
25 May 2018 (online)

Abstract

Background/aims The rate of recurrent small-bowel bleeding (SBB) remains high despite the advent of balloon assisted enteroscopy (BAE). The study aims were to determine: (1) the diagnostic and therapeutic yields, and adverse event rate of repeat BAE in SBB, and (2) the predictors of a positive repeat BAE.

Methods A retrospective review of a BAE database was conducted. Patients who had > 1 BAE for SBB were included. Primary outcomes were diagnostic yield, therapeutic yield, and adverse events of repeat BAE. Secondary outcomes were predictors of a positive repeat BAE.

Results A total of 175 patients (55 % men; mean age 64.1 ± 16.3 years) were included. The diagnostic and therapeutic yields of repeat BAE were 55 % and 42 %, respectively. Repeat BAE adverse events occurred in 5 % with self-limited abdominal pain being most common. Patients with a positive repeat BAE were significantly older than the negative group (68.6 ± 13.9 vs. 60.9 ± 17.1; P = 0.001) and were more likely to have cardiac comorbidities (OR 2.4, 95 %CI: 1.3 – 4.6; P = 0.01), chronic kidney disease (OR 2.3, 95 %CI: 1.1 – 4.9; P = 0.04), chronic obstructive pulmonary disease (OR 3.3, 95 %CI: 1.3 – 8.1; P = 0.01), positive initial BAE (OR 3.6, 95 %CI: 1.9 – 6.8; P < 0.001), and antegrade procedure (OR 3.3, 95 %CI: 1.7 – 6.1; P < 0.001). On multivariate analysis, a positive initial BAE and antegrade route were the only significant predictive factors.

Conclusions Performing a repeat BAE for SBB appears safe and provided modest yields. A positive initial BAE and antegrade route were predictive of a positive repeat BAE.