Abstract
Background The commonest therapeutic indications for double balloon enteroscopy (DBE) includes
removal of retained video capsules, dilatation of strictures, polypectomy, and managing
obscure small bowel bleeding. We review our experience in managing active small bowel
bleeding with DBE.
Methods A retrospective review was done for all the cases undergoing DBE from August 2017
to July 2019. Patient follow-up data was collected.
Results Among 25 cases with a median age of 46.8 (range 25–65 years), 17 males (68%) underwent
DBE for suspected small bowel bleeding. The commonest presenting complaint was melena
19 (76%). The findings were positive (diagnostic yield) in 18 (72%) patients with
an antegrade approach. Active bleeding was associated with Dieulafoy's lesion (n = 6), gastrointestinal stromal tumors (GIST) (n = 4), jejunal varices (n = 3), angioectasia (n = 3), and ulcer (n = 2), who then underwent successful intervention. The rest of the patients underwent
both antegrade and retrograde approach but failed to immediately identify an alternative
diagnosis. Mean (standard deviation [SD]) time taken for antegrade enteroscopy was
96.7 (15.3) mins and 67.8 (13.6) mins for retrograde enteroscopy. The median duration
between the last bleeding episode and timing of DBE was 9 (range 6–15 hours). No major
complications were seen during or immediately postprocedure.
Conclusion DBE is useful in identifying and treating active small bowel bleeding. Being invasive
and time-intensive, it is easy to miss lesions and, therefore, needs appropriate expertise.
DBE does appear to be relatively cheaper, with better patient acceptance and time
saving.
Keywords
double balloon enteroscopy - small bowel - anemia - gastrointestinal bleeding - outcomes
