Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 614-621
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.614
Assessment of multi-modality evaluations of obscure gastrointestinal bleeding
Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeff Fidler, Joel G Fletcher, John Barlow, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, Joseph J Larson, Felicity T Enders, David H Bruining, Nayantara Coelho-Prabhu
Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
Jeff Fidler, Joel G Fletcher, John Barlow, Division of Radiology, Mayo Clinic, Rochester, MN 55905, United States
Joseph J Larson, Felicity T Enders, Division of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Law R and Varayil JE contributed to data collection, data analysis, drafting of the manuscript; WongKeeSong LM, Fidler J, Fletcher JG, Barlow J, Alexander J, Rajan E and Hansel S contributed to critical review, final manuscript approval; Becker B contributed to research support, final manuscript approval; Larson JJ and Enders FT contributed to data analysis, final manuscript approval; Bruining DH and Coelho-Prabhu N contributed to project conception, data analysis, critical review, final manuscript approval.
Institutional review board statement: The study was reviewed and approved by the Mayo Clinic Institutional Review Board.
Informed consent statement: All study participants provided research authorization prior to study enrollment.
Conflict-of-interest statement: None of the authors have a conflict of interest or disclosures relevant to this manuscript.
Data sharing statement: Statistical code, and de-identified dataset available from the corresponding author at coelhoprabhu.nayantara@mayo.edu. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nayantara Coelho-Prabhu, MBBS, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. coelhoprabhu.nayantara@mayo.edu
Telephone: +1-507-2842407 Fax: +1-507-2842407
Received: August 11, 2016
Peer-review started: August 12, 2016
First decision: September 5, 2016
Revised: September 16, 2016
Accepted: October 19, 2016
Article in press: October 19, 2016
Published online: January 28, 2017
AIM
To determine the frequency of bleeding source detection in patients with obscure gastrointestinal bleeding (OGIB) who underwent double balloon enteroscopy (DBE) after pre-procedure imaging [multiphase computed tomography enterography (MPCTE), video capsule endoscopy (VCE), or both] and assess the impact of imaging on DBE diagnostic yield.
METHODS
Retrospective cohort study using a prospectively maintained database of all adult patients presenting with OGIB who underwent DBE from September 1st, 2002 to June 30th, 2013 at a single tertiary center.
RESULTS
Four hundred and ninety five patients (52% females; median age 68 years) underwent DBE for OGIB. AVCE and/or MPCTE performed within 1 year prior to DBE (in 441 patients) increased the diagnostic yield of DBE (67.1% with preceding imaging vs 59.5% without). Using DBE as the gold standard, VCE and MPCTE had a diagnostic yield of 72.7% and 32.5% respectively. There were no increased odds of finding a bleeding site at DBE compared to VCE (OR = 1.3, P = 0.150). There were increased odds of finding a bleeding site at DBE compared to MPCTE (OR = 5.9, P < 0.001). In inpatients with overt OGIB, diagnostic yield of DBE was not affected by preceding imaging.
CONCLUSION
DBE is a safe and well-tolerated procedure for the diagnosis and treatment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or MPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE.
Core tip: The yield of double balloon enteroscopy (DBE) without preceding video capsule endoscopy (VCE) or multiphase computed tomography enterography (MPCTE) was 59.4%, and with preceding imaging was 67.5%. Overall diagnostic yield of antegrade DBE is superior to CTE and equivalent to VCE in the evaluation of obscure gastrointestinal bleeding. The diagnostic yields of DBE for inpatients vs outpatients were similar but the highest sensitivity of VCE using DBE as gold standard was in inpatients (84.9%). The incremental diagnostic yield of DBE of all patients with negative preceding VCE and MPCTE was 66% (35/53 patients). An appropriate strategy might be antegrade DBE in inpatients with evidence of ongoing bleeding if DBE is available.
