Diagnosis and treatment of obscure GI bleeding at double balloon endoscopy

Naoki Ohmiya, Tomonori Yano, Hironori Yamamoto, Daigo Arakawa, Masanao Nakamura, Wataru Honda, Akihiro Itoh, Yoshiki Hirooka, Yasumasa Niwa, Osamu Maeda, Takafumi Ando, Tsuneyoshi Yao, Toshiyuki Matsui, Mitsuo Iida, Shinji Tanaka, Tsutomu Chiba, Choitsu Sakamoto, Kentaro Sugano, Hidemi Goto

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Abstract

Background: Double balloon endoscopy (DBE) and videocapsule endoscopy (VCE) have been useful in managing obscure GI bleeding (OGIB). Objective: This study evaluated the usefulness of DBE for diagnosis, treatment, and prognosis of OGIB and compared diagnostic yield between DBE and VCE in Japan. Methods: Detection rates of abnormalities and diagnostic yields between VCE and DBE were compared in 74 patients at 5 centers. Of 244 patients who underwent DBE at Nagoya University Hospital, 130 (53%) with OGIB were enrolled for investigation of therapeutic procedures. Setting: Seven Japanese medical centers. Patients: Of 1034 patients who underwent DBE between September 2000 and December 2005 at 7 medical centers, 479 (46%) with OGIB were enrolled. Results: Overall diagnostic yield of DBE for OGIB was 277 of 479 (58%). In patients with overt-ongoing bleeding, overt-previous bleeding of sporadic type, overt-previous bleeding of first attack only, occult bleeding with continuous positive fecal occult blood test (FOBT), or occult bleeding with 1 positive FOBT with iron deficiency anemia, diagnostic yield was 24 of 31 (77%), 179 of 310 (58%), 34 of 72 (47%), 24 of 35 (71%), and 56 of 93 (60%), respectively. Regarding positive findings in 277 patients, ulcers or erosions (53%) were the most frequent, followed by angiodysplasia (23%), tumors or polyps (22%), and diverticula (4%). Diagnoses in these patients were as follows: chronic inflammatory diseases (24%), vascular diseases (24%), tumor or polyps (21%), drug or radiation injury (7%), other small-bowel diseases (7%), upper GI diseases (9%), colorectal diseases (9%), and biliary disease (0.4%). Small-bowel diseases were confirmed in 226 patients (47%). Comparison of overall detection rate of abnormalities in the small bowel between VCE (65%) and DBE (53%) was not significantly different, nor was that of overall diagnostic yield between VCE (50%) and DBE (53%). Eight acute pancreatitis and 4 perforation episodes occurred with no mortalities at DBE. Of 130 patients at Nagoya University Hospital, 78 (60%) were diagnosed with small-bowel diseases and underwent treatments as follows: medication or observation only (n = 30), enteroscopic therapies (electrocoagulation in 21, clipping in 4, and polypectomy in 3), and surgery (n = 22). Small-bowel vascular diseases were more prone to rebleeding than small-bowel nonvascular diseases in patients without surgical treatment at a median follow-up of 423 days. Conclusions: DBE was relatively safe and useful for diagnosis and treatment of OGIB. A spectrum of small-bowel diseases presenting with OGIB in Japan may be distinct from that in the Western world.

Original languageEnglish
Pages (from-to)S72-S77
JournalGastrointestinal endoscopy
Volume66
Issue number3 SUPPL.
DOIs
Publication statusPublished - 01-09-2007
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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    Ohmiya, N., Yano, T., Yamamoto, H., Arakawa, D., Nakamura, M., Honda, W., Itoh, A., Hirooka, Y., Niwa, Y., Maeda, O., Ando, T., Yao, T., Matsui, T., Iida, M., Tanaka, S., Chiba, T., Sakamoto, C., Sugano, K., & Goto, H. (2007). Diagnosis and treatment of obscure GI bleeding at double balloon endoscopy. Gastrointestinal endoscopy, 66(3 SUPPL.), S72-S77. https://doi.org/10.1016/j.gie.2007.05.041