Endoscopy 2018; 50(04): S150-S151
DOI: 10.1055/s-0038-1637487
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

SPIRAL ENTEROSCOPY ROLE IN DIAGNOSING AND TREATMENT OF SMALL BOWELL VASCULAR LESIONS

T Atena Pop
1   University of Medicine and Pharmacy ‘Iuliu Hatieganu’, Cluj-Napoca, Romania
2   IRGH ‘Prof. Dr. Octavian Fodor’, Cluj-Napoca, Romania
,
O Mosteanu
1   University of Medicine and Pharmacy ‘Iuliu Hatieganu’, Cluj-Napoca, Romania
2   IRGH ‘Prof. Dr. Octavian Fodor’, Cluj-Napoca, Romania
,
M Tantau
1   University of Medicine and Pharmacy ‘Iuliu Hatieganu’, Cluj-Napoca, Romania
2   IRGH ‘Prof. Dr. Octavian Fodor’, Cluj-Napoca, Romania
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Management of small-bowel (SB) vascular lesions has undergone significant changes due to recent developments in enteroscopy. The aim was to assess the diagnostic and therapeutic yield of spiral enteroscopy (SE) in obscure gastro-intestinal bleeding (OGIB).

Methods:

We prospectively recorded 78 cases of SE performed for suspected midgut bleeding, in a Romanian tertiary center (October 2009 – May 2016). Mean age of patients was 54.6 years (range 18 – 72 years). All procedures were performed by the same team. All patients were previously assessed using entero-CT, which detected only the benign and malignant tumors.

Results:

In all patients SE progression was successful. The procedure was stopped when a diagnosis was reached (the lesion indicated by entero-CT or other significant lesion). Complete enteroscopy was performed in 9 patients with OGIB. SE detected relevant SB pathology in 67 of 78 (85.89%) patients. OGIB was caused by vascular lesions of the small bowel in 54.6% of patients: sporadic and hereditary angioectasia (32.43%), Dieulafoy lesions (26.7%), arteriovenous malformations 11.54%), occlusive (2.46% – volvulus) and non-occlusive intestinal ischemia (9.04%), portal hypertensive enteropathy (15.36%), vascular tumour (2.46% primary ileal angiosarcoma). 40% of the vascular lesions were found in the proximal jejunum. Mean duration of SE procedures was 35 ± 8 minutes (insertion and withdrawal, therapeutic time not included). Therapeutic hemostatic procedures, such as injection, argon plasma coagulation and hemostatic clip insertion were very satisfying due to the stability of the spiral overtube. Complications were only minor: edema/erythema of esophagus and at the ligament of Treitz.

Conclusions:

Our study confirmed that angioectasia are the main vascular lesions of small bowel. Also, in referred OGIB patients, due to the high percent of proximal lesions, we recommend to perform as a first step a push enteroscopy (using a colonoscope) instead of the second upper GI endoscopy.