Download PDF
Endoscopy 2009; 41(8): 715-717
DOI: 10.1055/s-0029-1214974
Case report

© Georg Thieme Verlag KG Stuttgart · New York

A retrospective analysis of emergency double-balloon enteroscopy for small-bowel bleeding

K.  Mönkemüller[*] 1 , 2 , H.  Neumann[*] 1 , F.  Meyer3 , R.  Kuhn3 , P.  Malfertheiner1 , L.  C.  Fry1 , 2
  • 1Department of Internal Medicine, Gastroenterology, and Infectious Diseases, Marienhospital, Bottrop, Germany
  • 2Division of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
  • 3Department of Surgery, Otto von Guericke University, Magdeburg, Germany
Further Information

Publication History

submitted21 January 2009

accepted after revision18 May 2009

Publication Date:
10 August 2009 (online)

Also available at
    Permissions and Reprints

Although the role of emergency esophagogastroduodenoscopy (EGD) and colonoscopy for upper and lower gastrointestinal bleeding (GIB) is well defined, there are no data on the concept of emergency double-balloon enteroscopy (DBE) for small-bowel bleeding. The aim of this study was to retrospectively evaluate the concept of emergency DBE in overt obscure GIB and assess its impact on patient management. A total of 17 emergency DBEs for overt obscure GIB were carried out in ten patients (six women, four men; mean age 68 years, range 35 – 83). The following diagnoses were made: actively bleeding Dieulafoy lesions of the small bowel, n = 2; bleeding tumors, n = 4 (carcinoids n = 2, adenocarcinoma n = 1, lipoma n = 1); bleeding angiodysplasias and/or large arteriovenous malformation (AVM), n = 2; multiple ulcers, n = 1; and no diagnosis, n = 1. Endoscopic therapies included argon plasma coagulation (n = 6), injection of epinephrine (n = 3), and use of fibrin glue (n = 1). It appears that emergency DBE is technically feasible, facilitates both diagnosis and therapy and enables management of patients with massive overt obscure GIB. This study is a first step in establishing the concept of emergency DBE for patients with suspected small-bowel bleeding.

References

  • 1 Zhong J, Ma T, Zhang C. et al . A retrospective study of the application of double-balloon enteroscopy in 378 patients with suspected small-bowel diseases.  Endoscopy. 2007;  39 208-215
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Safatle-Ribeiro A V, Kuga R, Ishida R. et al . Is double-balloon enteroscopy an accurate method to diagnose small-bowel disorders?.  Surg Endosc. 2007;  12 2231-2236
    PubMedSearch in Google Scholar
  • 3 Heine G D, Hadithi M, Groenen M J. et al . Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease.  Endoscopy. 2006;  38 42-48
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Ell C, May A, Nachbar L. et al . Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study.  Endoscopy. 2005;  37 613-616
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Raju G S, Gerson L, Das A, Lewis B. American Gastroenterological Association. . American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding.  Gastroenterology. 2007;  133 1697-1717
    CrossrefPubMedSearch in Google Scholar
  • 6 Ell C, May A. Mid-gastrointestinal bleeding: capsule endoscopy and push-and-pull enteroscopy give rise to a new medical term.  Endoscopy. 2006;  38 673-675
    PubMedSearch in Google Scholar
  • 7 Fry L C, Bellutti M, Neumann H. et al . Incidence of bleeding lesions within reach of conventional upper and lower endoscopes in patients undergoing double-balloon enteroscopy for obscure gastrointestinal bleeding.  Aliment Pharmacol Ther. 2009;  29 342-349
    CrossrefPubMedSearch in Google Scholar
  • 8 Kaffes A J, Siah C, Koo J H. Clinical outcomes after double-balloon enteroscopy in patients with obscure GI bleeding and a positive capsule endoscopy.  Gastrointest Endosc. 2007;  66 304-309
    CrossrefPubMedSearch in Google Scholar
  • 9 Pohl J, Blancas J M, Cave D. et al . Consensus report of the 2nd International Conference on double balloon endoscopy.  Endoscopy. 2008;  40 156-160
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Mönkemüller K, Bellutti M, Fry L C. et al . Enteroscopy.  Best Pract Res Clin Gastroenterol. 2009;  41 55-58
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Pennazio M, Santucci R, Rondonotti E. et al . Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases.  Gastroenterology. 2004;  126 643-653
    CrossrefPubMedSearch in Google Scholar
  • 12 Leighton J A, Triester S L, Sharma V K. Capsule endoscopy: a meta-analysis for use with obscure gastrointestinal bleeding and Crohn’s disease.  Gastrointest Endosc Clin N Am. 2006;  16 229-250
    CrossrefPubMedSearch in Google Scholar
  • 13 Mönkemüller K, Weigt J, Treiber G. et al . Diagnostic and therapeutic impact of double-balloon enteroscopy.  Endoscopy. 2006;  38 67-72
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Mensink P B, Haringsma J, Kucharzik T. et al . Complications of double balloon enteroscopy: a multicenter survey.  Endoscopy. 2007;  39 613-615
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Jensen D M, Machicado G A, Jutabha R, Kovacs T O. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage.  N Engl J Med. 2000;  342 78-82
    CrossrefPubMedSearch in Google Scholar
  • 16 Bjorkman D J, Zaman A, Fennerty M B. et al . Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study.  Gastrointest Endosc. 2004;  60 1-8
    CrossrefPubMedSearch in Google Scholar

1 Both authors contributed equally.

K. MönkemüllerMD, PhD, FASGE 

Department of Gastroenterology, Hepatology and Infectious Diseases
Marienhospital Bottrop

Josef-Albers-Str. 70
46236 Bottrop
Germany

Fax: +49-391-6713105

Email: klaus.moenkemueller@mhb-bottrop.de