Outcomes of repeat balloon assisted enteroscopy in small-bowel bleeding
submitted 06 October 2017
accepted after revision 20 February 2018
25 May 2018 (online)
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.
- 1 Gerson LB, Fidler JL, Cave DR. et al. ACG Clinical Guideline: Diagnosis and management of small bowel bleeding. Am J Gastroenterol 2015; 110: 1265-1287 ; quiz 1288
- 2 Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1997; 92: 419-424
- 3 Katz LB. The role of surgery in occult gastrointestinal bleeding. Semin Gastrointest Dis 1999; 10: 78-81
- 4 Gralnek IM. Obscure-overt gastrointestinal bleeding. Gastroenterology 2005; 128: 1424-1430
- 5 Yamamoto H, Sekine Y, Sato Y. et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53: 216-220
- 6 May A, Friesing-Sosnik T, Manner H. et al. Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding. Endoscopy 2011; 43: 759-765
- 7 Samaha E, Rahmi G, Landi B. et al. Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions. Am J Gastroenterol 2012; 107: 240-246
- 8 Gerson LB, Batenic MA, Newsom SL. et al. Long-term outcomes after double-balloon enteroscopy for obscure gastrointestinal bleeding. Clin Gastroenterol Hepatol 2009; 7: 664-669
- 9 Byeon JS, Mann NK, Jamil LH. et al. Is a repeat double balloon endoscopy in the same direction useful in patients with recurrent obscure gastrointestinal bleeding?. J Clin Gastroenterol 2013; 47: 496-500
- 10 Zhi FC, Yue H, Jiang B. et al. Diagnostic value of double balloon enteroscopy for small-intestinal disease: experience from China. Gastrointest Endosc 2007; 66: S19-21
- 11 Zhong J, Ma T, Zhang C. et al. A retrospective study of the application on double-balloon enteroscopy in 378 patients with suspected small-bowel diseases. Endoscopy 2007; 39: 208-215
- 12 Cazzato IA, Cammarota G, Nista EC. et al. Diagnostic and therapeutic impact of double-balloon enteroscopy (DBE) in a series of 100 patients with suspected small bowel diseases. Dig Liver Dis 2007; 39: 483-487
- 13 Manabe N, Tanaka S, Fukumoto A. et al. Double-balloon enteroscopy in patients with GI bleeding of obscure origin. Gastrointest Endosc 2006; 64: 135-140
- 14 Arakawa D, Ohmiya N, Nakamura M. et al. Outcome after enteroscopy for patients with obscure GI bleeding: diagnostic comparison between double-balloon endoscopy and videocapsule endoscopy. Gastrointest Endosc 2009; 69: 866-874
- 15 Teshima CW, Kuipers EJ, van Zanten SV. et al. Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis. J Gastroenterol Hepatol 2011; 26: 796-801
- 16 Monkemuller K, Neumann H, Meyer F. et al. A retrospective analysis of emergency double-balloon enteroscopy for small-bowel bleeding. Endoscopy 2009; 41: 715-717
- 17 Aniwan S, Viriyautsahakul V, Rerknimitr R. et al. Urgent double balloon endoscopy provides higher yields than non-urgent double balloon endoscopy in overt obscure gastrointestinal bleeding. Endosc Int Open 2014; 2: E90-E95
- 18 Lipka S, Rabbanifard R, Kumar A. et al. Single versus double balloon enteroscopy for small bowel diagnostics: a systematic review and meta-analysis. J Clin Gastroenterol 2015; 49: 177-184
- 19 Kaffes AJ, Siah C, Koo JH. Clinical outcomes after double-balloon enteroscopy in patients with obscure GI bleeding and a positive capsule endoscopy. Gastrointest Endosc 2007; 66: 304-309
- 20 Shinozaki S, Yano T, Sakamoto H. et al. Long-term outcomes in patients with overt obscure gastrointestinal bleeding after negative double-balloon endoscopy. Dig Dis Sci 2015; 60: 3691-3696
- 21 Rahmi G, Samaha E, Vahedi K. et al. Long-term follow-up of patients undergoing capsule and double-balloon enteroscopy for identification and treatment of small-bowel vascular lesions: a prospective, multicenter study. Endoscopy 2014; 46: 591-597
- 22 Khashab MA, Pasha SF, Muthusamy VR. et al. The role of deep enteroscopy in the management of small-bowel disorders. Gastrointest Endosc 2015; 82: 600-607
- 23 Moschler O, May AD, Muller MK. et al. [Complications in double-balloon-enteroscopy: results of the German DBE register]. Z Gastroenterol 2008; 46: 266-270
- 24 Mensink PB, Haringsma J, Kucharzik T. et al. Complications of double balloon enteroscopy: a multicenter survey. Endoscopy 2007; 39: 613-615