ROLE OF DOUBLE BALLOON ENTEROSCOPE AS AN INITIAL METHOD IN DIAGNOSIS AND TREATMENT OF PATIENTS WITH OBSCURE GASTROINTESTINAL BLEEDING

Aims:

Obscure GI bleeding (OGIB) had been defined as bleeding of unknown origin that persists or recurs after an initial negative investigation. Identifying the source of OGIB represents a diagnostic challenge. Conventional diagnostic methods, such as push enteroscope, small-bowel follow-through, radionuclide scanning, and angiography, all have their own inherent limitations. Double balloon enteroscope (DBE) was designed specifically for diagnosis of various small bowel diseases as well as therapeutic intervention. Due to our limited resources and unaffordability of capsule endoscopy the aim of the study to assess feasibility and efficacy of DBE as an initial diagnostic and therapeutic tool for OGIT.

Methods:

This study is a prospective study that was conducted on 93 patients with a mean age of 45 years presenting with OGIB referred for DBE without performing capsule endoscopy.

Results:

Fifteen patients had lesions outside the small intestine that accounted for obscure GI bleeding and were excluded. Within the 78 patients who underwent DBE, 24 patients (30.8%) had negative findings on enteroscopy.

The remaining 54 patients (69.2%) showed significant findings which included small intestinal tumors in 21 patients, vascular bleeding lesions in 27 patients and ulcerations in 6 patients. Endoscopic hemostasis was done in patients with vascular lesions. The three patients with Petuz-Jegher syndrome had polypectomy of their major polyps. Patients with gastrointestinal tumors were referred to surgery.

Conclusions:

According to our experience we recommend performance of second-look endoscopy prior to DBE as it revealed the source of bleeding in fifteen patients.

in expert hands DBE was an excellent choice with relatively high diagnostic and therapeutic yield for management of OGIT. The procedure is both feasible and has a high safety profile in all age groups.