Predictors for outcomes and readmission rates following double balloon enteroscopy: a tertiary care experience

Danielle Jarrard Shelnut; Omar T. Sims; Jenine N. Zaibaq; Hyejung Oh; Krishna V. Venkata; Shajan Peter

doi:10.1055/a-0602-3967

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(06): E751-E757
DOI: 10.1055/a-0602-3967

Original article

Predictors for outcomes and readmission rates following double balloon enteroscopy: a tertiary care experience

Danielle Jarrard Shelnut

¹University of Alabama at Birmingham, Tinsley Harrison Internal Medicine Residency, Birmingham, Alabama

,

Omar T. Sims

²University of Alabama at Birmingham, Department of Social Work, College of Arts and Sciences/Department of Health Behavior, School of Public Health/Center for AIDS Research/Comprehensive Center for Healthy Aging, Birmingham, Alabama

,

Jenine N. Zaibaq

¹University of Alabama at Birmingham, Tinsley Harrison Internal Medicine Residency, Birmingham, Alabama

,

Hyejung Oh

³Troy University, Dothan Campus Ringgold Standard Institution, Department of Human Services & Social Work, College of Health and Human Services, Dothan, Alabama

,

Krishna V. Venkata

⁴University of Alabama, Internal Medicine Residency, Montgomery, Alabama

,

Shajan Peter

⁵University of Alabama at Birmingham, Division of Gastroenterology and Hepatology, Birmingham, Alabama

› Institutsangaben

Abstract

Aim The objectives of this study are to examine clinical characteristics of patients undergoing anterograde and retrograde double balloon enteroscopy (DBE) and to assess factors predicting positive diagnostic yield, therapeutic yield, and readmission.

Methods We conducted a retrospective cohort study of patients (n = 420) who underwent DBE at a tertiary care center between 2012 and 2016 at a tertiary referral center. Measures of central tendency and frequency distributions were used for univariate analysis. Chi-square and t-test analyses were used to compare patient characteristics. Logistic regression was used to predict outcomes of interest.

Results Of patients included in the study, 59 % were male with a mean age of 61.49 (SD = 15.15) Altered anatomy was noted in 14 %, while 5 % and 13 % of patients had end stage renal disease (ESRD) and current use of anticoagulation, respectively. The most common indication for DBE was obscure gastrointestinal bleed (OGIB) (33 %). Forty-nine patients had obscure and overt gastrointestinal bleeding (GIB) and 22 % had occult GIB with iron deficiency. The cohort’s rate of positive diagnostic yield was 73 % and 35 % for therapeutic yield. The 30-day and 6-month readmission rates were both 11 %. A higher proportion of those readmitted were male (75 % vs 57 %, P = 0.027) and had longer procedural time (38.68 vs 46.57, P = 0.011). Likewise, occult GIB with iron deficiency anemia and iron deficiency alone (OR = 2.45, CI: 1.233 – 4.859, P = 0.011), inpatient status (OR 2.42, CI 1.344 – 4.346, P = 0.003), and longer procedural time (OR = 1.02, CI: 1.004 – 1.029, P = 0.008) were associated positively with readmission.

There were no statistically significant predictors of positive diagnostic yield, however procedural time (OR = 1.01, CI: 1.03 – 1.026; P = .0017) and older age (OR = 1.03, CI: 1.009 – 1.045, P = 0.003) were positively associated with therapeutic yield. Retrograde procedure (OR = 0.230, CI 0.125 – 0.422, P = 0.000) was negatively associated with therapeutic yield.

Conclusion DBE procedures have relevant efficacy for both diagnostic and therapeutic yield while evaluating small bowel disease. Readmission rates are low and more in those with GI bleed and iron deficiency with longer index procedural times.

Volltext

Referenzen

References
1 Skinner M, Peter S, Wilcox CM. et al. Diagnostic and therapeutic utility of double-balloon enteroscopy for obscure GI bleeding in patients with surgically altered upper GI anatomy. Gastrointest Endosc 2014; 80: 181-186
2 Velazquez-Avina J, Beyer R, Diaz-Tobar CP. et al. New method of direct percutaneous endoscopic jejunostomy tube placement using balloon-assisted enteroscopy with fluoroscopy. Dig Endosc 2015; 27: 317-322
3 Gerson LB, Batenic MA, Newsom SL. et al. Long-term outcomes after double-balloon enteroscopy for obscure gastrointestinal bleeding. Clin Gastroenterol Hepatol 2009; 7: 664-669
4 Moreels TG. Update in enteroscopy: New devices and new indications. Digestive Endosc 2017; 30: 174-181
5 Law JK. New developments in small bowel enteroscopy. Curr Opin Gastroenterol 2016; 32: 387-391
6 Gerson LB, Fidler JL, Cave DR. et al. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding. Am J Gastroenterol 2015; 110: 1265-687; quiz 88
7 Gerson LB. Small bowel bleeding: updated algorithm and outcomes. Gastrointest Endosc Clin N Am 2017; 27: 171-180
8 Santhakumar C, Liu K. Evaluation and outcomes of patients with obscure gastrointestinal bleeding. World J Gastrointest Pathophysiol 2014; 5: 479-486
9 Samaha E, Rahmi G, Landi B. et al. Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions. Am J Gastroenterol 2012; 107: 240-246
10 Kaffes AJ, Siah C, Koo JH. Clinical outcomes after double-balloon enteroscopy in patients with obscure GI bleeding and a positive capsule endoscopy. Gastrointest Endosc 2007; 66: 304-309
11 Shishido T, Oka S, Tanaka S. et al. Outcome of patients who have undergone total enteroscopy for obscure gastrointestinal bleeding. World J Gastrointest 2012; 18: 666-672
12 Monkemuller K, Weigt J, Treiber G. et al. Diagnostic and therapeutic impact of double-balloon enteroscopy. Endoscopy 2006; 38: 67-72
13 Suzuki T, Matsushima M, Okita I. et al. Clinical utility of double-balloon enteroscopy for small intestinal bleeding. Dig Dis Sci 2007; 52: 1914-1918
14 Xin L, Liao Z, Jiang YP. et al. Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double-balloon endoscopy: a systematic review of data over the first decade of use. Gastrointest Endosc 2011; 74: 563-570
15 Jovanovic I, Vormbrock K, Zimmermann L. et al. Therapeutic double-balloon enteroscopy: a binational, three-center experience. Dig Dis 2011; 29 (Suppl. 01) 27-31
16 Yamamoto H, Kita H, Sunada K. et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2004; 2: 1010-1016
17 Hussan H, Crews NR, Geremakis CM. et al. Predictors of double balloon endoscopy outcomes in the evaluation of gastrointestinal bleeding. World J Gastrointest Endosc 2014; 6: 248-253
18 Yamamoto H, Sekine Y, Sato Y. et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53: 216-220
19 Committee AT, Chauhan SS, Manfredi MA. et al. Enteroscopy. Gastrointest Endosc 2015; 82: 975-990
20 Serrao S, Jackson C, Juma D. et al. In-hospital weekend outcomes in patients diagnosed with bleeding gastroduodenal angiodysplasia: a population-based study, 2000 to 2011. Gastrointest Endosc 2016; 84: 416-423
21 Jackson CS, Gerson LB. Management of gastrointestinal angiodysplastic lesions (GIADs): a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 474-483; quiz 84
22 Rutgeerts P, Van Gompel F, Geboes K. et al. Long term results of treatment of vascular malformations of the gastrointestinal tract by neodymium Yag laser photocoagulation. Gut 1985; 26: 586-593
23 Sanaka MR, Navaneethan U, Kosuru B. et al. Antegrade is more effective than retrograde enteroscopy for evaluation and management of suspected small-bowel disease. Clin Gastroenterol Hepatol 2012; 10: 910-916
24 Sun B, Rajan E, Cheng S. et al. Diagnostic yield and therapeutic impact of double-balloon enteroscopy in a large cohort of patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2006; 101: 2011-2015