Published online Jun 16, 2014. doi: 10.4253/wjge.v6.i6.248
Revised: March 5, 2014
Accepted: May 16, 2014
Published online: June 16, 2014
Processing time: 152 Days and 11.3 Hours
AIM: To identify patients’ characteristics associated with double balloon endoscopy (DBE) outcomes in investigation of obscure gastrointestinal bleeding (OGIB).
METHODS: Retrospective study performed at an academic tertiary referral center. Evaluated endpoints were clinical factors associated with no diagnostic yield or non-therapeutic intervention of DBE performed for OGIB evaluation.
RESULTS: We included fifty-five DBE between August 2010 and April 2012. The mean age of the sample was 67 with 32 males (58.2%). Twenty-four DBE had no diagnostic yield and 30 DBE did not require therapy. Non-diagnostic yield was associated with performing two or more DBE studies in one day [odds ratio (OR): 13.72, P = 0.008], absence of blood transfusions within a year of the DBE (OR: 7.16, P = 0.03) and absence of ulcers or arteriovenous malformations (AVMs) on prior esophagogastroduodenoscopy (EGD) or colonoscopy (OR: 19.30, P = 0.033). Non-therapeutic DBE was associated with performing two or more DBE per day (OR: 18.579, P = 0.007), gastrointestinal bleeding episode within a week of the DBE (OR: 11.48, P = 0.003), fewer blood transfusion requirements prior to DBE (OR: 4.55, P = 0.036) and absence of ulcers or AVMs on prior EGD or colonoscopy (OR: 8.47, P = 0.027).
CONCLUSION: Predictors of DBE yield and therapeutic intervention on DBE include blood transfusion requirements, previous endoscopic findings and possibly endoscopist fatigue.
Core tip: Double balloon endoscopy (DBE) is an excellent tool to visualize the small bowel and provide treatment. However, it may be unable to identify a source for bleeding in 20% to 40% of obscure gastrointestinal bleeding (OGIB) cases. This small retrospective case-control study showed that factors such as fewer blood transfusion requirements, absence of arteriovenous malformations or ulcers on prior endoscopies and possibly endoscopist fatigue may predict a negative diagnostic and therapeutic yield of DBE. This may help manage patients with OGIB and multiple comorbidities and potentially reduce health care costs by classifying patients who are most likely to benefit from this time intensive procedure.