Background and Study Aims: Small-bowel enteroscopy (SBE) is frequently used to examine patients suspected of small-bowel disease. Unfortunately, the diagnostic yield varies widely, from 13 % to 78 % of cases. This disparity may be in part attributable to the vast array of indications for the use of the procedure. The purpose of this study was to examine the diagnostic yield of small-bowel enteroscopy for various indications. Patients and Methods: This is a retrospective cohort study of all patients who underwent SBE over a 5-year period, from 1995 to 1999. Results: The indications were grouped into in-patient gastrointestinal blood loss (46 % of the patient population), outpatient gastrointestinal blood loss (33 %), abnormal radiographic study (7 %), iron-deficiency anemia (5 %), and others (9 %, defined as anemia not otherwise specified, abdominal pain, nausea and vomiting, diarrhea, and weight loss). The overall diagnostic yield was 42 %. Gastrointestinal bleeding had the highest yield, at 44 % (in-patient gastrointestinal blood loss 51 %, outpatient gastrointestinal blood loss 40 %; P = 0.1314). Patients with iron-deficiency anemia had a yield of 42 %, and patients with a previous abnormal radiograph had a yield of 41 %. The combined diagnostic yield for the indications in the “other” category was 21 % - significantly lower than in patients with gastrointestinal bleeding, abnormal radiographs, and iron deficiency (P = 0.049). Conclusions: SBE is safe and useful in the evaluation of small-bowel disease. Although the overall yield is highly dependent on the specific indication, it is effective for patients with in-patient or outpatient gastrointestinal blood loss, patients with abnormal radiographs that demonstrate small-bowel pathology considered to be within reach of the enteroscope, and iron-deficiency anemia. There are insufficient data to support the use of enteroscopy for other indications such as anemia not otherwise specified, abdominal pain, nausea and vomiting, and chronic diarrhea, and in these cases it is unlikely to be useful.
References
1
Lewis B S.
Small intestinal bleeding.
Gastroenterol Clin North Am.
1994;
23
67-91
2
Myers R T.
Diagnosis and management of occult gastrointestinal bleeding: visualization of the small bowel lumen by fiberoptic colonoscope.
Am Surg.
1976;
42
92-95
4
Voeller G R, Bunch G, Britt L G.
Use of technetium-labeled red blood cell scintigraphy in the detection and management of gastrointestinal hemorrhage.
Surgery.
1991;
110
799-804
7
Richardson J D, McInnis W D, Ramos R, Aust J B.
Occult gastrointestinal bleeding: an evaluation of available diagnostic methods.
Arch Surg.
1975;
110
661-665
8
Hershko C, Vitells A, Braverman D Z.
Causes of iron deficiency anemia in an adult in-patient population: effect of diagnostic workup on etiologic distribution.
Blut.
1984;
49
347-352
9
Zuckerman G, Benitez J.
A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding.
Am J Gastroenterol.
1992;
87
62-66
10
Appleyard M, Fireman Z, Glukhovsky A. et al .
A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions.
Gastroenterology.
2000;
119
1431-1438
14
Foutch P G, Sawyer R, Sanowski R A.
Push-enteroscopy for diagnosis of patients with gastrointestinal bleeding of obscure origin.
Gastrointest Endosc.
1990;
36
337-341
15
Adrain A L, Dabezies M A, Krevsky B.
Enteroscopy improves the clinical outcome in patients with obscure gastrointestinal bleeding.
J Laparoendosc Adv Surg Tech A.
1998;
8
279-284
16
Chong J, Tagle M, Barkin J S, Reiner D K.
Small bowel push-type fiberoptic enteroscopy for patients with occult gastrointestinal bleeding or suspected small bowel pathology.
Am J Gastroenterol.
1994;
89
2143-2146
17
Chak A, Koehler M K, Sundaram S N. et al .
Diagnostic and therapeutic impact of push enteroscopy: analysis of factors associated with positive findings.
Gastrointest Endosc.
1998;
47
18-22
21
Schmit A, Gay F, Adler M. et al .
Diagnostic efficacy of push-enteroscopy and long-term follow-up of patients with small bowel angiodysplasias.
Dig Dis Sci.
1996;
41
2348-2352
23
Zaman A, Katon R M.
Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope.
Gastrointest Endosc.
1998;
47
372-376
24
Cuillerier E, Landi B, Cellier C.
Is push enteroscopy useful in patients with malabsorption of unclear origin?.
Am J Gastroenterol.
2001;
96
2103-2106
26
Benz C, Martin W R, Arnold J. et al .
Endoscopic study of the small intestine with push enteroscopy: a prospective study [in German].
Dtsch Med Wochenschr.
1997;
122
391-395