(Don’t) Let the Mid-Gut Bleed - Impact of Enteroscopy

Aims Suspected small bowel bleeding (SSBB) is the main indication for enteroscopy. SSBB studies are characterized by a reduced sample size, rarely including data from both enteroscopic techniques. We assessed in a large cohort of SSBB patients the impact of videocapsule (VCE) and double balloon enteroscopy (DBE).

Methods We retrospectively evaluated consecutive patients with SSBB who underwent VCE and/or DBE from March 2001 to July 2020. Demographic and clinical parameters, concomitant anticoagulant therapies, technical characteristics and adverse events were collected. We assessed effectiveness of anteroscopy in terms of diagnostic yield (DY), concordance between the two investigations, hemoglobin values before and after DBE, and safety of the procedures.

Results 751 patients underwent enteroscopy for SSBB (807 VCEs, 407 DBEs). The DY was significantly higher in DBE than VCE (68.8 % vs 57.7 %), being the highest (75 %) in DBE performed for overt active bleeding. For both procedures, the DY was significantly higher in elderly patients.

Agreement was generally suboptimal (k=0.059), improving in case of a 1-5 days (k=0.323) and a 1-7 days (k=0.222) interval between the two procedures.

The post-procedural mean hemoglobin values were significantly higher than the pre-enteroscopy ones (p < 0.0001).

No capsular retentions have been recorded. In case of DBE, 8 (1 %) mild adverse events occurred (6 in DBE performed for SSBB). In patients treated with Direct Oral Anticoagulants (DOACs) (23; 19 VCEs, 12 DBEs) there were no differences in DY, safety and clinical impact.

Conclusions This study describes the broadest European monocentric cohort. VCE and DBE play a pivotal role in the diagnostic-therapeutic approach of SSBB. Concordance between VCE and DBE demonstrated the importance of performing these procedures as soon as possible. The clinical impact is high in elderly patients and in patients treated with DOACs, maintained also during follow-up.

Citation: Scaramella L, Topa M, Tontini GE et al. OP5 (DON’T) LET THE MID-GUT BLEED - IMPACT OF ENTEROSCOPY. Endoscopy 2021; 53: S7.

Publication History

Article published online:
19 March 2021