Rebleeding rates after argon plasma coagulation

The study by May et al. [1] contributes to our understanding of the effectiveness of argon plasma coagulation (APC) during double-balloon enteroscopy (DBE) for small-bowel bleeding. The authors analyzed the outcome comprehensively by discussing the results from other articles and examining the limitations of the study. The article has some clinical value due to the long follow-up period and the combination of APC and DBE.

However, there are some questions about the results. First, details of when and where hemoglobin levels were measured were not presented for the study; the time points of measurement and the hospitals used for testing the hemoglobin should have been recorded in order to accurately analyze this parameter. Secondly, the bleeding symptoms and blood transfusion requirements of patients should be confirmed so that the rebleeding rate can be calculated accurately. The definition of rebleeding should be stated explicitly.

Furthermore, the miss rate of DBE may also influence the rebleeding rate. Gerson et al. showed that the rates of recurrent bleeding were high in patients with DBE examinations that showed normal mucosa along the full insertion depth of the endoscope [2]. Thus, the miss rates of different hospitals should be considered when examining the results.

References

• 1 May A, Friesing-Sosnik T, Manner H et al. Long-term outcome after argon plasma coagulation of small-bowel lesions using double-balloon enteroscopy in patients with mid-gastrointestinal bleeding.  Endoscopy. 2011;  43 759-765
• 2 Gerson L B, Batenic M A, Newsom S L et al. Long-term outcomes after double balloon enteroscopy for obscure gastrointestinal bleeding.  Clin Gastroenterol Hepatol. 2009;  7 664-669