Predictors for outcomes and readmission rates following double balloon enteroscopy: a tertiary care experience
submitted 17 July 2017
accepted after revision 07 March 2018
05 June 2018 (online)
Aim The objectives of this study are to examine clinical characteristics of patients undergoing anterograde and retrograde double balloon enteroscopy (DBE) and to assess factors predicting positive diagnostic yield, therapeutic yield, and readmission.
Methods We conducted a retrospective cohort study of patients (n = 420) who underwent DBE at a tertiary care center between 2012 and 2016 at a tertiary referral center. Measures of central tendency and frequency distributions were used for univariate analysis. Chi-square and t-test analyses were used to compare patient characteristics. Logistic regression was used to predict outcomes of interest.
Results Of patients included in the study, 59 % were male with a mean age of 61.49 (SD = 15.15) Altered anatomy was noted in 14 %, while 5 % and 13 % of patients had end stage renal disease (ESRD) and current use of anticoagulation, respectively. The most common indication for DBE was obscure gastrointestinal bleed (OGIB) (33 %). Forty-nine patients had obscure and overt gastrointestinal bleeding (GIB) and 22 % had occult GIB with iron deficiency. The cohort’s rate of positive diagnostic yield was 73 % and 35 % for therapeutic yield. The 30-day and 6-month readmission rates were both 11 %. A higher proportion of those readmitted were male (75 % vs 57 %, P = 0.027) and had longer procedural time (38.68 vs 46.57, P = 0.011). Likewise, occult GIB with iron deficiency anemia and iron deficiency alone (OR = 2.45, CI: 1.233 – 4.859, P = 0.011), inpatient status (OR 2.42, CI 1.344 – 4.346, P = 0.003), and longer procedural time (OR = 1.02, CI: 1.004 – 1.029, P = 0.008) were associated positively with readmission.
There were no statistically significant predictors of positive diagnostic yield, however procedural time (OR = 1.01, CI: 1.03 – 1.026; P = .0017) and older age (OR = 1.03, CI: 1.009 – 1.045, P = 0.003) were positively associated with therapeutic yield. Retrograde procedure (OR = 0.230, CI 0.125 – 0.422, P = 0.000) was negatively associated with therapeutic yield.
Conclusion DBE procedures have relevant efficacy for both diagnostic and therapeutic yield while evaluating small bowel disease. Readmission rates are low and more in those with GI bleed and iron deficiency with longer index procedural times.
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