Therapeutic Impact of Deep Balloon-assisted Small Bowel Enteroscopy on Red Blood Cell Transfusion

Amandeep S. Kalra; Andrew J. Walker; Mark E. Benson; Nalini M. Guda; Anurag Soni; Mehak Misha; Deepak V. Gopal

doi:10.1055/s-0040-1721552

Journal of Digestive Endoscopy, Table of Contents

CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2020; 11(04): 258-262
DOI: 10.1055/s-0040-1721552

Research Article

Therapeutic Impact of Deep Balloon-assisted Small Bowel Enteroscopy on Red Blood Cell Transfusion

Amandeep S. Kalra

¹Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States

,

Andrew J. Walker

²SSM Health System–Dean Medical Group, Madison, Wisconsin, United States

,

Mark E. Benson

¹Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States

,

Nalini M. Guda

³Division of Gastroenterology and Hepatology, School of Medicine and Public Health, University of Wisconsin, GI Associates - Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, United States

,

Anurag Soni

¹Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States

,

Mehak Misha

⁴Gundersen Hospitals and Clinics, La Crosse, Wisconsin, United States

,

Deepak V. Gopal

¹Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States

› Author Affiliations

Abstract

Objective Evaluate impact of balloon-assisted deep small bowel enteroscopy on red blood cell transfusion requirement in patients with obscure gastrointestinal (GI) bleeding.

Methods Retrospective study of patients, who underwent balloon-assisted deep enteroscopy with double-balloon enteroscopy (DBE) at two tertiary care academic centers (University of Wisconsin and Aurora St. Luke’s Medical Center) over a 55-month consecutive period. Sixty-nine patients with reliable blood transfusion records were identified during this time period. DBE was preceded by small bowel capsule endoscopy (CE) within 1 year in 38 cases. Transfusion requirements 6 months prior and postintervention were measured to see if DBE had any impact on the need for blood transfusions.

Results Sixty-nine patients (25 females and 44 males) were included. Mean age ± standard deviation (SD) was 63 ± 17 years. Wilcoxon signed rank test statistics were used to find the difference in the rate of blood transfusion. There was a statistically significant decrease in rate of packed red blood cell (pRBC) transfusion post DBE and endoscopic therapy with coagulation (p < 0.001). Argon plasma coagulation was used to ablate all arteriovenous malformations (AVMs) except in one (subepithelial lesion). Those that required > 5 units pRBC transfusions pre-DBE had the most benefit.

Conclusions Our study demonstrates that transfusion requirements are significantly reduced in those undergoing therapy with DBE and coagulation for obscure GI bleed.

Keywords

DBE–double-balloon enteroscopy - OGIB–obscure gastrointestinal bleeding - red blood transfusion - therapeutic endoscopy

Full Text

References

References
1 Laine L, Sahota A, Shah A. Does capsule endoscopy improve outcomes in obscure gastrointestinal bleeding? Randomized trial versus dedicated small bowel radiography. Gastroenterology 2010; 138 (05) 1673-1680.e1, quiz e11–e12
2 Liu K, Kaffes AJ. Review article: the diagnosis and investigation of obscure gastrointestinal bleeding. Aliment Pharmacol Ther 2011; 34 (04) 416-423
3 Goenka MK, Majumder S, Kumar S, Sethy PK, Goenka U. Single center experience of capsule endoscopy in patients with obscure gastrointestinal bleeding. World J Gastroenterol 2011; 17 (06) 774-778
4 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 (02) 304-309
5 Raju GS, Gerson L, Das A, Lewis B. American Gastroenterological Association. American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding. Gastroenterology 2007; 133 (05) 1697-1717
6 Gerson LB, Batenic MA, Newsom SL, Ross A, Semrad CE. Long-term outcomes after double-balloon enteroscopy for obscure gastrointestinal bleeding. Clin Gastroenterol Hepatol 2009; 7 (06) 664-669
7 Lee NM, Eisen GM. 10 years of capsule endoscopy: an update. Expert Rev Gastroenterol Hepatol 2010; 4 (04) 503-512
8 Cooley DM, Walker AJ, Gopal DV. From capsule endoscopy to balloon-assisted deep enteroscopy: exploring small-bowel endoscopic imaging. Gastroenterol Hepatol (N Y) 2015; 11 (03) 143-154
9 Yamamoto H, Sekine Y, Sato Y. et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53 (02) 216-220
10 May A, Friesing-Sosnik T, Manner H, Pohl J, Ell C. Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding. Endoscopy 2011; 43 (09) 759-765
11 Sun B, Rajan E, Cheng S. et al. Diagnostic yield and therapeutic impact of double-balloon enteroscopy in a large cohort of patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2006; 101 (09) 2011-2015
12 Madisch A, Schmolders J, Brückner S, Aust D, Miehlke S. Less favorable clinical outcome after diagnostic and interventional double balloon enteroscopy in patients with suspected small-bowel bleeding?. Endoscopy 2008; 40 (09) 731-734
13 Shinozaki S, Yamamoto H, Yano T. et al. Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy. Clin Gastroenterol Hepatol 2010; 8 (02) 151-158
14 Kalra AS, Walker AJ, Benson ME. et al. Comparison of capsule endoscopy findings to subsequent double balloon enteroscopy: a dual center experience. Diagn Ther Endosc 2015; 2015: 438757
15 Prabakaran P, Guda N, Thomas J. et al. Clinical approach to obscure GI bleeding-Diagnostic testing and management. J Digestive Endoscopy 2013; 4 (03) 61
16 Brito HP, Ribeiro IB, de Moura DTH. et al. Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: A systematic review and meta-analysis. World J Gastrointest Endosc 2018; 10 (12) 400-421
17 Park JJ, Cheon JH, Kim HM. et al. Negative capsule endoscopy without subsequent enteroscopy does not predict lower long-term rebleeding rates in patients with obscure GI bleeding. Gastrointest Endosc 2010; 71 (06) 990-997
18 Hussan H, Crews NR, Geremakis CM, Bahna S, LaBundy JL, Hachem C. Predictors of double balloon endoscopy outcomes in the evaluation of gastrointestinal bleeding. World J Gastrointest Endosc 2014; 6 (06) 248-253
19 Su MY, Lin WP, Chiu CT. Experience of double balloon enteroscopy. J Chin Med Assoc 2018; 81 (03) 225-229
20 Wu CR, Huang LY, Song B, Yi LZ, Cui J. Application of double-balloon enteroscopy in the diagnosis and therapy of small intestinal diseases. Chin Med J (Engl) 2007; 120 (23) 2075-2080
21 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 (05) 483-487